Provider Demographics
NPI:1508100835
Name:DERAMUS HEARING AID CENTERA
Entity Type:Organization
Organization Name:DERAMUS HEARING AID CENTERA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DERAMUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-262-7553
Mailing Address - Street 1:2809 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36107-3007
Mailing Address - Country:US
Mailing Address - Phone:334-262-7553
Mailing Address - Fax:334-261-3132
Practice Address - Street 1:2809 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36107-3007
Practice Address - Country:US
Practice Address - Phone:334-262-7553
Practice Address - Fax:334-261-3132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA231H00000X
AL1051A235Z00000X
AL4136237600000X
MSHA0593237700000X
AL11284237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1689954976OtherNPI
FL1124308366OtherNPI
AL1801040621OtherNPI
FL1962754010OtherNPI
AL1578892642OtherNPI