Provider Demographics
NPI:1912042136
Name:SOUTHEASTERN HEARING INC.
Entity Type:Organization
Organization Name:SOUTHEASTERN HEARING INC.
Other - Org Name:CLEAR EAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-220-3277
Mailing Address - Street 1:12220 ATLANTIC BLVD
Mailing Address - Street 2:UNIT 113
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-5822
Mailing Address - Country:US
Mailing Address - Phone:904-220-3277
Mailing Address - Fax:
Practice Address - Street 1:12220 ATLANTIC BLVD
Practice Address - Street 2:UNIT 113
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-5822
Practice Address - Country:US
Practice Address - Phone:904-220-3277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2210302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization