Provider Demographics
NPI:1477601680
Name:DAVENPORT HEARING AID CENTER, INC
Entity Type:Organization
Organization Name:DAVENPORT HEARING AID CENTER, INC
Other - Org Name:DAVENPORT AUDIOLOGY HEARING AID CENTER, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DOCTOR OF AUDIOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHEAL CHARLES
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:563-386-8885
Mailing Address - Street 1:430 W 35TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-5820
Mailing Address - Country:US
Mailing Address - Phone:563-386-8885
Mailing Address - Fax:563-386-5860
Practice Address - Street 1:430 W 35TH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-5820
Practice Address - Country:US
Practice Address - Phone:563-386-8885
Practice Address - Fax:563-386-5860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-07
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA170231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0012799Medicaid
IAI5548Medicare PIN
IA0012799Medicaid