Provider Demographics
NPI:1063648707
Name:JESTERS HEARING AID CENETR
Entity Type:Organization
Organization Name:JESTERS HEARING AID CENETR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BC-HIS
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:JESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-845-8150
Mailing Address - Street 1:595 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-2217
Mailing Address - Country:US
Mailing Address - Phone:951-845-8150
Mailing Address - Fax:
Practice Address - Street 1:595 E 6TH ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-2217
Practice Address - Country:US
Practice Address - Phone:951-845-8150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA1406332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1194862771Medicaid