Provider Demographics
NPI:1922394154
Name:NORTHSIDE HEARING CARE
Entity Type:Organization
Organization Name:NORTHSIDE HEARING CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HENDRICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-818-3490
Mailing Address - Street 1:12938 BLALOCK DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-7702
Mailing Address - Country:US
Mailing Address - Phone:317-801-3399
Mailing Address - Fax:317-536-3541
Practice Address - Street 1:1180 MEDICAL CT STE A
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2986
Practice Address - Country:US
Practice Address - Phone:317-818-3490
Practice Address - Fax:317-536-3541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech