Provider Demographics
NPI:1326051079
Name:NORTH FLORIDA HEARING SERVICES
Entity Type:Organization
Organization Name:NORTH FLORIDA HEARING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:850-584-3277
Mailing Address - Street 1:1224 N PEACOCK AVE
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32347-2117
Mailing Address - Country:US
Mailing Address - Phone:859-584-3277
Mailing Address - Fax:850-584-4738
Practice Address - Street 1:1224 N PEACOCK AVE
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32347-2117
Practice Address - Country:US
Practice Address - Phone:859-584-3277
Practice Address - Fax:850-584-4738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY941261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS2985OtherBCBS