Provider Demographics
NPI:1225899354
Name:HEARING CENTER OF ANDOVER LLC
Entity Type:Organization
Organization Name:HEARING CENTER OF ANDOVER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-232-0177
Mailing Address - Street 1:1881 STATION PKWY NW STE A
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-3366
Mailing Address - Country:US
Mailing Address - Phone:763-232-0177
Mailing Address - Fax:
Practice Address - Street 1:1881 STATION PKWY NW STE A
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-3366
Practice Address - Country:US
Practice Address - Phone:763-232-0177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment