Provider Demographics
NPI:1114251915
Name:OREGON HEARING CENTER LLC
Entity Type:Organization
Organization Name:OREGON HEARING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORTEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:419-690-8267
Mailing Address - Street 1:3241 NAVARRE AVE
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3311
Mailing Address - Country:US
Mailing Address - Phone:419-690-8267
Mailing Address - Fax:419-690-8324
Practice Address - Street 1:3241 NAVARRE AVE
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3311
Practice Address - Country:US
Practice Address - Phone:419-690-8267
Practice Address - Fax:419-690-8324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-25
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02876237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH237700000XMedicare PIN