Provider Demographics
NPI:1639326051
Name:ABBOTT HEARING CENTERS OF AZ, INC.
Entity Type:Organization
Organization Name:ABBOTT HEARING CENTERS OF AZ, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:B
Authorized Official - Last Name:KUETTEL
Authorized Official - Suffix:
Authorized Official - Credentials:ACA
Authorized Official - Phone:480-325-9097
Mailing Address - Street 1:319 S POWER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-5295
Mailing Address - Country:US
Mailing Address - Phone:480-325-9097
Mailing Address - Fax:480-924-7930
Practice Address - Street 1:319 S POWER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-5295
Practice Address - Country:US
Practice Address - Phone:480-325-9097
Practice Address - Fax:480-924-7930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1878237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty