Provider Demographics
NPI:1710266440
Name:SUTTER HEARING AID CENTER
Entity Type:Organization
Organization Name:SUTTER HEARING AID CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEARING INSTRUMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:EMALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-466-2443
Mailing Address - Street 1:2087 GRAND CANAL BLVD STE 9
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6651
Mailing Address - Country:US
Mailing Address - Phone:209-466-2443
Mailing Address - Fax:209-466-2124
Practice Address - Street 1:2087 GRAND CANAL BLVD STE 9
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6651
Practice Address - Country:US
Practice Address - Phone:209-466-2443
Practice Address - Fax:209-466-2124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA3210237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1144321118Medicaid