Provider Demographics
NPI:1649896093
Name:CLEAR CHOICE LEASING
Entity type:Organization
Organization Name:CLEAR CHOICE LEASING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:TIBBLE
Authorized Official - Suffix:
Authorized Official - Credentials:HAD
Authorized Official - Phone:928-581-3036
Mailing Address - Street 1:8 WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-5093
Mailing Address - Country:US
Mailing Address - Phone:928-581-3036
Mailing Address - Fax:
Practice Address - Street 1:8 WILDWOOD DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-5093
Practice Address - Country:US
Practice Address - Phone:928-581-3036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty