Provider Demographics
NPI:1467871913
Name:MT. HARRISON AUDIOLOGY AND HEARING AIDS LLC
Entity Type:Organization
Organization Name:MT. HARRISON AUDIOLOGY AND HEARING AIDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:WILCOX
Authorized Official - Last Name:PICKUP
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:208-312-0957
Mailing Address - Street 1:1218 9TH ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:RUPERT
Mailing Address - State:ID
Mailing Address - Zip Code:83350-2207
Mailing Address - Country:US
Mailing Address - Phone:208-312-0957
Mailing Address - Fax:
Practice Address - Street 1:1218 9TH ST
Practice Address - Street 2:UNIT 2
Practice Address - City:RUPERT
Practice Address - State:ID
Practice Address - Zip Code:83350-2207
Practice Address - Country:US
Practice Address - Phone:208-312-0957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAUD-1529261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech