Provider Demographics
NPI:1437396405
Name:JOEL C. ROSS M.D. INC.
Entity Type:Organization
Organization Name:JOEL C. ROSS M.D. INC.
Other - Org Name:A CENTER FOR HEARING HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-724-1095
Mailing Address - Street 1:1700 SAN PABLO AVE STE F
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2082
Mailing Address - Country:US
Mailing Address - Phone:510-724-1095
Mailing Address - Fax:
Practice Address - Street 1:1700 SAN PABLO AVE STE F
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2082
Practice Address - Country:US
Practice Address - Phone:510-724-1095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOEL C. ROSS MD INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-13
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG1114174400000X
CA3644332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332S00000XSuppliersHearing Aid Equipment
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1154368835OtherMEDI-CAL
CA1154368835Medicare UPIN