Provider Demographics
NPI:1659640860
Name:ELKS HEARING AND BALANCE CENTER
Entity Type:Organization
Organization Name:ELKS HEARING AND BALANCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:STURMAK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-A, F-AAA
Authorized Official - Phone:208-489-4975
Mailing Address - Street 1:520 S EAGLE RD
Mailing Address - Street 2:SUITE 1225
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6351
Mailing Address - Country:US
Mailing Address - Phone:208-489-5999
Mailing Address - Fax:208-888-2496
Practice Address - Street 1:520 S EAGLE RD
Practice Address - Street 2:SUITE 1225
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6351
Practice Address - Country:US
Practice Address - Phone:208-489-5999
Practice Address - Fax:208-888-2496
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IDAHO ELKS REHABILITATION HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAUD-2112231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty