Provider Demographics
NPI:1740387315
Name:EASY HEARING CLINIC LLC
Entity Type:Organization
Organization Name:EASY HEARING CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:KMETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-829-2162
Mailing Address - Street 1:215 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-3331
Mailing Address - Country:US
Mailing Address - Phone:218-829-2162
Mailing Address - Fax:
Practice Address - Street 1:215 N 3RD ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-3331
Practice Address - Country:US
Practice Address - Phone:218-829-2162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7307231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN161081OtherUCARE
MN96G60EAOtherMN BLUE CROSS BLUE SHIELD