Provider Demographics
NPI:1710146014
Name:AUDIOLOGY & HEARING AID SERVICES
Entity Type:Organization
Organization Name:AUDIOLOGY & HEARING AID SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:FAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:207-797-8738
Mailing Address - Street 1:985 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3303
Mailing Address - Country:US
Mailing Address - Phone:207-797-8738
Mailing Address - Fax:207-797-8650
Practice Address - Street 1:985 FOREST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3303
Practice Address - Country:US
Practice Address - Phone:207-797-8738
Practice Address - Fax:207-797-8650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP25237600000X
MEAP1825237600000X
MEDL20000383237700000X
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