Provider Demographics
NPI:1558013938
Name:FAIRWAY HEARING CENTER L.L.C.
Entity Type:Organization
Organization Name:FAIRWAY HEARING CENTER L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIVONEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MEHRER
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:267-319-2767
Mailing Address - Street 1:45 DOCS PLACE EXT
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19967-6751
Mailing Address - Country:US
Mailing Address - Phone:267-319-2767
Mailing Address - Fax:
Practice Address - Street 1:32566 DOCS PL EXTENSION, UNIT 2
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:DE
Practice Address - Zip Code:19967-6959
Practice Address - Country:US
Practice Address - Phone:302-251-8252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEO3-0010283OtherDE STATE LICENSE