Provider Demographics
NPI:1972634798
Name:ONTARIO AUDIOLOGY & HEARING AIDS, LLC
Entity Type:Organization
Organization Name:ONTARIO AUDIOLOGY & HEARING AIDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-881-0970
Mailing Address - Street 1:1159 SW 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-2129
Mailing Address - Country:US
Mailing Address - Phone:541-881-0970
Mailing Address - Fax:541-881-0971
Practice Address - Street 1:1159 SW 4TH AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2129
Practice Address - Country:US
Practice Address - Phone:541-881-0970
Practice Address - Fax:541-881-0971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR209580Medicaid