Provider Demographics
NPI:1376984898
Name:MALLORY VENTSAM ENTERPRISES, LLC
Entity Type:Organization
Organization Name:MALLORY VENTSAM ENTERPRISES, LLC
Other - Org Name:ALL ABOUT HEARING AIDS GULF COAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MALLORY
Authorized Official - Middle Name:
Authorized Official - Last Name:VENTSAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-797-6500
Mailing Address - Street 1:12627 PORTMARNOCK DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-5416
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2340 STATE ROAD 580
Practice Address - Street 2:UNIT N
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-1151
Practice Address - Country:US
Practice Address - Phone:727-797-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment