Provider Demographics
NPI:1558590265
Name:MUTTER'S PRECISION HEARING CENTER, INC
Entity Type:Organization
Organization Name:MUTTER'S PRECISION HEARING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:MUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:HAS
Authorized Official - Phone:772-871-1222
Mailing Address - Street 1:1680 SW SAINT LUCIE WEST BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1927
Mailing Address - Country:US
Mailing Address - Phone:772-871-1222
Mailing Address - Fax:
Practice Address - Street 1:1680 SW SAINT LUCIE WEST BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1927
Practice Address - Country:US
Practice Address - Phone:772-871-1222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS3398332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL610205100Medicaid