Provider Demographics
NPI:1326104035
Name:PROV35 INC
Entity Type:Organization
Organization Name:PROV35 INC
Other - Org Name:BELTONE BETTER HEARING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER SOLE
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LINDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:BS HIS
Authorized Official - Phone:847-742-6616
Mailing Address - Street 1:75 MARKET ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-5093
Mailing Address - Country:US
Mailing Address - Phone:847-742-6616
Mailing Address - Fax:847-742-5735
Practice Address - Street 1:75 MARKET ST
Practice Address - Street 2:SUITE 9
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5093
Practice Address - Country:US
Practice Address - Phone:847-742-6616
Practice Address - Fax:847-742-5735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2900237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4522353OtherBCBSIL
IL7402787OtherAETNA