Basic Information
| Provider Information | |||||||||
| NPI: | 1821447012 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEST | ||||||||
| FirstName: | HENRY | ||||||||
| MiddleName: | ROBERTS | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 17167 | ||||||||
| Address2: | |||||||||
| City: | HATTIESBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394047167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012615995 | ||||||||
| FaxNumber: | 6012615335 | ||||||||
| Practice Location | |||||||||
| Address1: | 3901 HARDY ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | HATTIESBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394021696 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012615995 | ||||||||
| FaxNumber: | 6012615335 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2016 | ||||||||
| LastUpdateDate: | 06/08/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | HA0643 | MS | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.