Provider Demographics
NPI:1275918542
Name:ELK GROVE HEARING CARE
Entity Type:Organization
Organization Name:ELK GROVE HEARING CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DISPENSER
Authorized Official - Prefix:MR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:PHILLIPS
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:916-627-1494
Mailing Address - Street 1:9300 W STOCKTON BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-8070
Mailing Address - Country:US
Mailing Address - Phone:916-627-1494
Mailing Address - Fax:
Practice Address - Street 1:9300 W STOCKTON BLVD STE 103
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-8070
Practice Address - Country:US
Practice Address - Phone:916-627-1494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2591237600000X
CAHA7877237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1881844298OtherNPPES
1295154326OtherNPPES