Provider Demographics
NPI:1700023272
Name:HEARING HEALTH CENTERS, P.C.
Entity Type:Organization
Organization Name:HEARING HEALTH CENTERS, P.C.
Other - Org Name:FAIRMONT HEARING AID SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:R ALPH
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:712-262-7774
Mailing Address - Street 1:119 E 5TH ST
Mailing Address - Street 2:PO BOX 17
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-5012
Mailing Address - Country:US
Mailing Address - Phone:712-262-7774
Mailing Address - Fax:
Practice Address - Street 1:230 S GRANT ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-3936
Practice Address - Country:US
Practice Address - Phone:507-235-5323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2032237600000X
MN8435237600000X
MN2080237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8G060FAOtherBLUE PLUS
MN9850563800Medicaid
MN987366000Medicaid
MN116805OtherUCARE