Provider Demographics
NPI:1477701282
Name:KELLYS HEAR CARE CENTERS
Entity Type:Organization
Organization Name:KELLYS HEAR CARE CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:III
Authorized Official - Credentials:NBC-HIS
Authorized Official - Phone:954-354-3738
Mailing Address - Street 1:600 FAIRWAY DRIVE
Mailing Address - Street 2:STE 100
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441
Mailing Address - Country:US
Mailing Address - Phone:954-354-3738
Mailing Address - Fax:954-354-0171
Practice Address - Street 1:600 FAIRWAY DRIVE
Practice Address - Street 2:STE 100
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441
Practice Address - Country:US
Practice Address - Phone:941-795-2811
Practice Address - Fax:941-795-4889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS2745231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJ8168OtherBLCR/BLSHIED