Provider Demographics
NPI:1346853397
Name:LEGACY HEARING PROFESSIONALS LLC
Entity Type:Organization
Organization Name:LEGACY HEARING PROFESSIONALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:ELI
Authorized Official - Last Name:KATICH
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:602-999-0805
Mailing Address - Street 1:1228 S SOSSAMAN RD STE 103
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-3438
Mailing Address - Country:US
Mailing Address - Phone:480-984-4327
Mailing Address - Fax:480-984-4363
Practice Address - Street 1:1228 S SOSSAMAN RD STE 103
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-3438
Practice Address - Country:US
Practice Address - Phone:480-984-4327
Practice Address - Fax:480-984-4363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech