Provider Demographics
NPI:1013036169
Name:SOUTH IDAHO HEARING & AUDIOLOGY
Entity Type:Organization
Organization Name:SOUTH IDAHO HEARING & AUDIOLOGY
Other - Org Name:SIHA
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SEITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-734-4555
Mailing Address - Street 1:112 SEMINOLE CIRLCE
Mailing Address - Street 2:
Mailing Address - City:JEROME
Mailing Address - State:ID
Mailing Address - Zip Code:83338
Mailing Address - Country:US
Mailing Address - Phone:208-324-4414
Mailing Address - Fax:
Practice Address - Street 1:1330 FILER AVE E
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4119
Practice Address - Country:US
Practice Address - Phone:208-734-4555
Practice Address - Fax:208-734-3632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1378218Medicare ID - Type UnspecifiedMEDICARE GRP NO