Basic Information
Provider Information | |||||||||
NPI: | 1730276304 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | GADSDEN HEARING AID, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | WRIGHT HEARING CENTER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 110 RILEY ST | ||||||||
Address2: |   | ||||||||
City: | GADSDEN | ||||||||
State: | AL | ||||||||
PostalCode: | 359015432 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2565472373 | ||||||||
FaxNumber: | 2565475353 | ||||||||
Practice Location | |||||||||
Address1: | 110 RILEY ST | ||||||||
Address2: |   | ||||||||
City: | GADSDEN | ||||||||
State: | AL | ||||||||
PostalCode: | 359015432 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2565472373 | ||||||||
FaxNumber: | 2565475353 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/06/2006 | ||||||||
LastUpdateDate: | 07/03/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | WRIGHT | ||||||||
AuthorizedOfficialFirstName: | TODD | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 2565472373 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | NBC-HIS | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332S00000X | 4016 | AL | Y |   | Suppliers | Hearing Aid Equipment |   |
ID Information
ID | Type | State | Issuer | Description | 174075400 | 01 | AL | DEPARTMENT OF LABOR | OTHER | 51056770 | 01 | AL | BLUE CROSS BLUE SHIELD | OTHER |