Provider Demographics
NPI:1417689480
Name:PREMIER HEARING AID & AUDIOLOGY
Entity Type:Organization
Organization Name:PREMIER HEARING AID & AUDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-792-8500
Mailing Address - Street 1:255 TERRACINA BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4881
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:255 TERRACINA BLVD STE 201
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4881
Practice Address - Country:US
Practice Address - Phone:909-792-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment