Basic Information
| Provider Information | |||||||||
| NPI: | 1760812770 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AUDIOLOGY DISTRIBUTION, LLC | ||||||||
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| OtherOrganizationName: | HEARUSA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT 3298 | ||||||||
| Address2: | |||||||||
| City: | CAROL STREAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601323298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003233277 | ||||||||
| FaxNumber: | 5615987231 | ||||||||
| Practice Location | |||||||||
| Address1: | 1450 S DOBSON RD | ||||||||
| Address2: | SUITE A-203 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852024712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802456622 | ||||||||
| FaxNumber: | 4802456623 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2013 | ||||||||
| LastUpdateDate: | 11/13/2013 | ||||||||
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| AuthorizedOfficialLastName: | KLEIN | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 80032332477 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.