Provider Demographics
NPI:1790960094
Name:CENTRUM HEARING SERVICES, INC
Entity Type:Organization
Organization Name:CENTRUM HEARING SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CONLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-232-3131
Mailing Address - Street 1:804 YELLOWSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4415
Mailing Address - Country:US
Mailing Address - Phone:208-232-3131
Mailing Address - Fax:208-233-8351
Practice Address - Street 1:804 YELLOWSTONE AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4415
Practice Address - Country:US
Practice Address - Phone:208-232-3131
Practice Address - Fax:208-233-8351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDHA-384305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization