Provider Demographics
NPI:1558690206
Name:HERMISTON HEARING AID CENTER
Entity Type:Organization
Organization Name:HERMISTON HEARING AID CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER-LLC
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:541-567-4063
Mailing Address - Street 1:405 N. 1ST ST.
Mailing Address - Street 2:SUITE 107
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838
Mailing Address - Country:US
Mailing Address - Phone:541-567-4063
Mailing Address - Fax:541-289-5064
Practice Address - Street 1:405 N. 1ST ST.
Practice Address - Street 2:SUITE 107
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838
Practice Address - Country:US
Practice Address - Phone:541-567-4063
Practice Address - Fax:541-289-5064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHAS-P-278859237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty