Provider Demographics
NPI:1821260910
Name:PHYSICIANS HEARING CARE
Entity Type:Organization
Organization Name:PHYSICIANS HEARING CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BRADEN
Authorized Official - Suffix:I
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:904-637-0990
Mailing Address - Street 1:1689 EAGLE HARBOR PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4817
Mailing Address - Country:US
Mailing Address - Phone:904-637-0990
Mailing Address - Fax:904-278-3968
Practice Address - Street 1:1689 EAGLE HARBOR PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32003-4817
Practice Address - Country:US
Practice Address - Phone:904-637-0990
Practice Address - Fax:904-278-3968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS2577332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment