Provider Demographics
NPI:1144585183
Name:WALES HEARING CENTER
Entity Type:Organization
Organization Name:WALES HEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/HEALTHCARE PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:WALES
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:320-762-2505
Mailing Address - Street 1:1501 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-2537
Mailing Address - Country:US
Mailing Address - Phone:320-762-2505
Mailing Address - Fax:320-763-9010
Practice Address - Street 1:1501 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-2537
Practice Address - Country:US
Practice Address - Phone:320-762-2505
Practice Address - Fax:320-763-9010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2034237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty