Basic Information
| Provider Information | |||||||||
| NPI: | 1710427786 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | METATE LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | ANTHEM HEARING CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2349 ROSENDALE VILLAGE AVE | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890528731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023638524 | ||||||||
| FaxNumber: | 7023638524 | ||||||||
| Practice Location | |||||||||
| Address1: | 11201 S EASTERN AVE | ||||||||
| Address2: | SUITE 215 | ||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890526201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024056955 | ||||||||
| FaxNumber: | 7024056956 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2017 | ||||||||
| LastUpdateDate: | 02/24/2017 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | SCHWENDEMANN | ||||||||
| AuthorizedOfficialFirstName: | ERNEST | ||||||||
| AuthorizedOfficialMiddleName: | LEE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/HIS | ||||||||
| AuthorizedOfficialTelephone: | 7024056955 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | BC-HIS | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332S00000X | 204 | NV | Y | Suppliers | Hearing Aid Equipment |
No ID Information.