Provider Demographics
NPI:1881019693
Name:SUMMIT HEARING AID CENTER
Entity Type:Organization
Organization Name:SUMMIT HEARING AID CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:719-594-2095
Mailing Address - Street 1:1817 N UNION BLVD
Mailing Address - Street 2:STE. C
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-2268
Mailing Address - Country:US
Mailing Address - Phone:719-594-2095
Mailing Address - Fax:719-633-6168
Practice Address - Street 1:1817 N UNION BLVD
Practice Address - Street 2:STE. C
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-2268
Practice Address - Country:US
Practice Address - Phone:719-594-2095
Practice Address - Fax:719-633-6168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COHA184332B00000X, 332BC3200X, 332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment