Provider Demographics
NPI:1568622231
Name:MOUNTAIN VIEW HEARING AID CENTER
Entity Type:Organization
Organization Name:MOUNTAIN VIEW HEARING AID CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER LICENSED HEARING INSTRUME
Authorized Official - Prefix:MS
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:CASTELLANO
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:503-912-1273
Mailing Address - Street 1:PO BOX 2255
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97024-2255
Mailing Address - Country:US
Mailing Address - Phone:503-912-1273
Mailing Address - Fax:503-912-1274
Practice Address - Street 1:3845 NE DIVISION ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030
Practice Address - Country:US
Practice Address - Phone:503-912-1273
Practice Address - Fax:503-912-1274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHASP1007990261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech