Provider Demographics
NPI:1073754552
Name:MR. PHILLIPS HEARING CENTER, INC.
Entity Type:Organization
Organization Name:MR. PHILLIPS HEARING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEARING AID DISPENSER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:208-529-4969
Mailing Address - Street 1:3153 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-6717
Mailing Address - Country:US
Mailing Address - Phone:208-529-4969
Mailing Address - Fax:208-529-6976
Practice Address - Street 1:3153 E 17TH ST
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-6717
Practice Address - Country:US
Practice Address - Phone:208-529-4969
Practice Address - Fax:208-529-6976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDHA-1012237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty