Basic Information
| Provider Information | |||||||||
| NPI: | 1720060452 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHERN HEARING ASSOCIATES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 310901 | ||||||||
| Address2: | |||||||||
| City: | ENTERPRISE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 363310901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3343936688 | ||||||||
| FaxNumber: | 3343937011 | ||||||||
| Practice Location | |||||||||
| Address1: | 107 E WATTS ST | ||||||||
| Address2: | |||||||||
| City: | ENTERPRISE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 363302511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3343936688 | ||||||||
| FaxNumber: | 3343937011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2005 | ||||||||
| LastUpdateDate: | 02/28/2013 | ||||||||
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| AuthorizedOfficialLastName: | TOOMEY | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3343936688 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | BC-HIS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 4124 | AL | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.