Provider Demographics
NPI:1063657898
Name:IMPERIAL TEN STAR, INC
Entity Type:Organization
Organization Name:IMPERIAL TEN STAR, INC
Other - Org Name:HEARING CARE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FITTER/DISPENSER
Authorized Official - Prefix:
Authorized Official - First Name:MARION
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHER
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:509-838-1526
Mailing Address - Street 1:210 E WELLESLEY AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1414
Mailing Address - Country:US
Mailing Address - Phone:509-838-1526
Mailing Address - Fax:509-624-6219
Practice Address - Street 1:210 E WELLESLEY AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1414
Practice Address - Country:US
Practice Address - Phone:509-838-1526
Practice Address - Fax:509-624-6219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA 00000013332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA122585OtherLABOR AND INDUSTRIES