Provider Demographics
NPI:1467748343
Name:AMERICAN HEARING & BALANCE CENTERS, INC
Entity Type:Organization
Organization Name:AMERICAN HEARING & BALANCE CENTERS, INC
Other - Org Name:AMERICAN HEARING & BALANCE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.F.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:GLASSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:HEARING SPECIALIST
Authorized Official - Phone:310-775-7795
Mailing Address - Street 1:703 PIER AVE
Mailing Address - Street 2:STE B-145
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-3949
Mailing Address - Country:US
Mailing Address - Phone:310-625-5657
Mailing Address - Fax:310-818-5551
Practice Address - Street 1:2001 SANTA MONICA BLVD
Practice Address - Street 2:STE 870W
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2102
Practice Address - Country:US
Practice Address - Phone:888-419-2775
Practice Address - Fax:310-818-5551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-20
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48648207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA51131Medicare UPIN
CAA51101Medicare UPIN