Provider Demographics
NPI:1851411300
Name:LIVINGSTON HEARING AID SERVICE
Entity Type:Organization
Organization Name:LIVINGSTON HEARING AID SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEARING INSTRUMENT SALES AND SERV.
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:W
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:319-377-1810
Mailing Address - Street 1:1375 7TH AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-3450
Mailing Address - Country:US
Mailing Address - Phone:319-377-1810
Mailing Address - Fax:319-377-1810
Practice Address - Street 1:1375 7TH AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-3450
Practice Address - Country:US
Practice Address - Phone:319-377-1810
Practice Address - Fax:319-377-1810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0825332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0746826Medicaid