Provider Demographics
NPI:1467702191
Name:MARSHALL ENT HEARING AIDS
Entity Type:Organization
Organization Name:MARSHALL ENT HEARING AIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:MASDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-593-7266
Mailing Address - Street 1:704 MEDICAL CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:BOAZ
Mailing Address - State:AL
Mailing Address - Zip Code:35957-5935
Mailing Address - Country:US
Mailing Address - Phone:256-593-7266
Mailing Address - Fax:256-840-9833
Practice Address - Street 1:704 MEDICAL CENTER PKWY
Practice Address - Street 2:
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35957-5935
Practice Address - Country:US
Practice Address - Phone:256-593-7266
Practice Address - Fax:256-840-9833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1106A237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty