Provider Demographics
NPI:1578987111
Name:MITCHELL HEARING AID CENTER INC.
Entity Type:Organization
Organization Name:MITCHELL HEARING AID CENTER INC.
Other - Org Name:SOUND ADVICE HEARING AID CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WAHLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-352-1585
Mailing Address - Street 1:1288 DAKOTA AVE S
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350-3600
Mailing Address - Country:US
Mailing Address - Phone:605-352-1585
Mailing Address - Fax:605-352-9046
Practice Address - Street 1:1288 DAKOTA AVE S
Practice Address - Street 2:SUITE 1
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-3600
Practice Address - Country:US
Practice Address - Phone:605-352-1585
Practice Address - Fax:605-352-9046
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MITCHELL HEARING AID CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD288H237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9162300Medicaid