Provider Demographics
NPI:1619946340
Name:CRISSCO, INC
Entity Type:Organization
Organization Name:CRISSCO, INC
Other - Org Name:BELTONE HEARING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CRISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-735-5679
Mailing Address - Street 1:415 N MORAIN ST
Mailing Address - Street 2:STE C
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2667
Mailing Address - Country:US
Mailing Address - Phone:509-735-5679
Mailing Address - Fax:509-735-5681
Practice Address - Street 1:415 N MORAIN ST
Practice Address - Street 2:STE C
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2667
Practice Address - Country:US
Practice Address - Phone:509-735-5679
Practice Address - Fax:509-735-5681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3666332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9058165Medicaid