Provider Demographics
NPI:1043621717
Name:PROFESSIONAL HEARING CENTER, PC
Entity Type:Organization
Organization Name:PROFESSIONAL HEARING CENTER, PC
Other - Org Name:DAILEY HEARING CENTER, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-721-8960
Mailing Address - Street 1:415 E 23RD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2393
Mailing Address - Country:US
Mailing Address - Phone:402-721-8960
Mailing Address - Fax:402-721-7988
Practice Address - Street 1:415 E 23RD ST
Practice Address - Street 2:SUITE A
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2393
Practice Address - Country:US
Practice Address - Phone:402-721-8960
Practice Address - Fax:402-721-7988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENA2112OtherMEDICARE PTAN