Provider Demographics
NPI:1518521723
Name:HEARING DOCTORS OF IDAHO, LLC
Entity Type:Organization
Organization Name:HEARING DOCTORS OF IDAHO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:BATEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:208-284-8790
Mailing Address - Street 1:618 N SENORA WAY
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6893
Mailing Address - Country:US
Mailing Address - Phone:208-284-8790
Mailing Address - Fax:
Practice Address - Street 1:459 LOCUST ST N STE 110
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-7324
Practice Address - Country:US
Practice Address - Phone:208-969-9011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-24
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1538456900OtherINDIVIDUAL NPI
ID1023189446OtherINDIVIDUAL NPI