Provider Demographics
NPI:1144227059
Name:EAR RX, INC.
Entity Type:Organization
Organization Name:EAR RX, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-237-9100
Mailing Address - Street 1:18636 STARCREEK DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-9330
Mailing Address - Country:US
Mailing Address - Phone:704-237-9100
Mailing Address - Fax:704-895-8883
Practice Address - Street 1:18636 STARCREEK DR
Practice Address - Street 2:SUITE E
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-9330
Practice Address - Country:US
Practice Address - Phone:704-237-9100
Practice Address - Fax:704-895-8883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7001522Medicaid
NC7001522Medicaid