Provider Demographics
NPI:1184897217
Name:SHEA HEARING AID CENTER
Entity type:Organization
Organization Name:SHEA HEARING AID CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHEA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:901-761-9720
Mailing Address - Street 1:6133 POPLAR PIKE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4707
Mailing Address - Country:US
Mailing Address - Phone:901-415-6667
Mailing Address - Fax:901-415-6648
Practice Address - Street 1:6133 POPLAR PIKE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4707
Practice Address - Country:US
Practice Address - Phone:901-415-6667
Practice Address - Fax:901-415-6648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0521604332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment