Provider Demographics
NPI:1073652673
Name:PACIFIC HEARING CLINIC INC.
Entity Type:Organization
Organization Name:PACIFIC HEARING CLINIC INC.
Other - Org Name:PACIFIC HEARING SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND AUDIOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:HILDRETH
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:650-366-9605
Mailing Address - Street 1:3555 ALAMEDA DE LAS PULGAS
Mailing Address - Street 2:1
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-6509
Mailing Address - Country:US
Mailing Address - Phone:650-854-1980
Mailing Address - Fax:650-854-1987
Practice Address - Street 1:3555 ALAMEDA DE LAS PULGAS
Practice Address - Street 2:1
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-6509
Practice Address - Country:US
Practice Address - Phone:650-854-1980
Practice Address - Fax:650-854-1987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0023741Medicaid
CAZZZ05599ZMedicare PIN