Basic Information
Provider Information | |||||||||
NPI: | 1922403856 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LAHER | ||||||||
FirstName: | SIDNEY | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | BC-HIS | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HICKS | ||||||||
OtherFirstName: | SIDNEY | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 815 ENGLEWOOD RD | ||||||||
Address2: |   | ||||||||
City: | MADISONVILLE | ||||||||
State: | TN | ||||||||
PostalCode: | 373545103 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4235453022 | ||||||||
FaxNumber: | 4235459749 | ||||||||
Practice Location | |||||||||
Address1: | 815 ENGLEWOOD RD | ||||||||
Address2: |   | ||||||||
City: | MADISONVILLE | ||||||||
State: | TN | ||||||||
PostalCode: | 373545103 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4235453022 | ||||||||
FaxNumber: | 8442736287 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/04/2014 | ||||||||
LastUpdateDate: | 02/17/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 02/17/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 748 | TN | Y |   | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |   |
No ID Information.