Provider Demographics
NPI:1235597220
Name:EAR-CENTRAL, PLLC
Entity Type:Organization
Organization Name:EAR-CENTRAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:OLAN
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:520-227-4523
Mailing Address - Street 1:4524 E HEREFORD RD
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85615-8813
Mailing Address - Country:US
Mailing Address - Phone:877-508-1130
Mailing Address - Fax:877-508-1130
Practice Address - Street 1:4524 E HEREFORD RD
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:AZ
Practice Address - Zip Code:85615-8813
Practice Address - Country:US
Practice Address - Phone:877-508-1130
Practice Address - Fax:877-508-1130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z177761OtherMEDICARE P10