Provider Demographics
NPI:1407057490
Name:EASTERN IOWA HEARING AID SVC
Entity Type:Organization
Organization Name:EASTERN IOWA HEARING AID SVC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:DOVE
Authorized Official - Suffix:
Authorized Official - Credentials:LHIS
Authorized Official - Phone:319-294-3003
Mailing Address - Street 1:5436 BLAIRS FOREST WAY NE
Mailing Address - Street 2:BLAIRS FOREST PLAZA
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-8802
Mailing Address - Country:US
Mailing Address - Phone:319-294-3003
Mailing Address - Fax:319-294-3009
Practice Address - Street 1:5436 BLAIRS FOREST WAY NE
Practice Address - Street 2:BLAIRS FOREST PLAZA
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-8802
Practice Address - Country:US
Practice Address - Phone:319-294-3003
Practice Address - Fax:319-294-3009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0112714Medicaid