Provider Demographics
NPI:1346410990
Name:WAKEFIELD HEARING CENTER
Entity Type:Organization
Organization Name:WAKEFIELD HEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WAKEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:701-746-7000
Mailing Address - Street 1:2514 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6776
Mailing Address - Country:US
Mailing Address - Phone:701-746-7000
Mailing Address - Fax:701-746-5220
Practice Address - Street 1:2514 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6776
Practice Address - Country:US
Practice Address - Phone:701-746-7000
Practice Address - Fax:701-746-5220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7G771WAOtherBCBS
ND24303OtherBCBS
ND57635Medicaid