Provider Demographics
NPI:1639471675
Name:ARIZONA EAR AND HEARING
Entity Type:Organization
Organization Name:ARIZONA EAR AND HEARING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF AUDIOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RATIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:480-292-7100
Mailing Address - Street 1:21321 E OCOTILLO RD STE 111
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-5993
Mailing Address - Country:US
Mailing Address - Phone:480-292-7100
Mailing Address - Fax:480-306-6237
Practice Address - Street 1:550 E 32ND ST STE 1
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-3431
Practice Address - Country:US
Practice Address - Phone:480-292-7100
Practice Address - Fax:480-306-6237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA2177231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ8889206Medicaid
AZZ121324Medicare PIN
AZZ121323Medicare PIN