Provider Demographics
NPI:1477649937
Name:WESTERN HEARING AID SERVICE
Entity Type:Organization
Organization Name:WESTERN HEARING AID SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/HEARING AID DISPENSER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-469-7328
Mailing Address - Street 1:P.O. BOX 6149
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85312-6149
Mailing Address - Country:US
Mailing Address - Phone:602-469-7328
Mailing Address - Fax:
Practice Address - Street 1:6143 W. SUNNYSIDE DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304
Practice Address - Country:US
Practice Address - Phone:602-469-7328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ285332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0902670OtherBC/BS