Provider Demographics
NPI:1588657845
Name:HEARING SERVICES CENTER INC
Entity Type:Organization
Organization Name:HEARING SERVICES CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:RUST
Authorized Official - Last Name:GRABER
Authorized Official - Suffix:
Authorized Official - Credentials:MA/AUDIOLOGY
Authorized Official - Phone:209-368-9222
Mailing Address - Street 1:1101 W TOKAY ST
Mailing Address - Street 2:STE 4
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-3808
Mailing Address - Country:US
Mailing Address - Phone:209-368-9222
Mailing Address - Fax:209-368-4662
Practice Address - Street 1:1101 W TOKAY ST
Practice Address - Street 2:STE 4
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-3808
Practice Address - Country:US
Practice Address - Phone:209-368-9222
Practice Address - Fax:209-368-9222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU570237600000X
CAAU1831237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGAU000680Medicaid
ZZZ51192ZOtherBLUE SHIELD
ZZZ51192ZOtherBLUE SHIELD