Basic Information
| Provider Information | |||||||||
| NPI: | 1770094161 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEAR AGAIN LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MIDLAND HEARING ASSOCIATES/A DIVISION OF HEAR AGAIN AMERICA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 851 BROKEN SOUND PKWY NW STE 120 | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334873638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613671623 | ||||||||
| FaxNumber: | 5612995438 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 WELLNESS BLVD STE 108 | ||||||||
| Address2: | |||||||||
| City: | IRMO | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290632872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037651919 | ||||||||
| FaxNumber: | 8038498875 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2017 | ||||||||
| LastUpdateDate: | 11/07/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MANOR | ||||||||
| AuthorizedOfficialFirstName: | LEAH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CORPORATE INSURANCE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5613671623 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HEAR AGAIN LLC | ||||||||
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| NPICertificationDate: | 11/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0700X | N | Ambulatory Health Care Facilities | Clinic/Center | Hearing and Speech | 231H00000X | 1067 | SC | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 1063599512 | 01 | PROVIDER NPI | OTHER | SA0061 | 05 | SC | MEDICAID |