Provider Demographics
NPI:1053502856
Name:SOUTH SEATTLE HEARING AIDS
Entity Type:Organization
Organization Name:SOUTH SEATTLE HEARING AIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:HUGH
Authorized Official - Last Name:MCCLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-242-3696
Mailing Address - Street 1:16259 SYLVESTER RD SW
Mailing Address - Street 2:SUITE 505
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3049
Mailing Address - Country:US
Mailing Address - Phone:206-242-3696
Mailing Address - Fax:206-246-1078
Practice Address - Street 1:16259 SYLVESTER RD SW
Practice Address - Street 2:SUITE 505
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3049
Practice Address - Country:US
Practice Address - Phone:206-242-3696
Practice Address - Fax:206-246-1078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9034679Medicaid
WA067985OtherLABOR AND INDUSTRIES