Provider Demographics
NPI:1134516859
Name:HEAR-MART, LLC.
Entity Type:Organization
Organization Name:HEAR-MART, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-782-8318
Mailing Address - Street 1:9142 SHENANDOAH RUN
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-5455
Mailing Address - Country:US
Mailing Address - Phone:815-782-8318
Mailing Address - Fax:815-782-8397
Practice Address - Street 1:6767 N WICKHAM RD
Practice Address - Street 2:STE 400
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2031
Practice Address - Country:US
Practice Address - Phone:813-413-6527
Practice Address - Fax:813-413-6527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment