Provider Demographics
NPI:1831390764
Name:UP-STATE HEARING INSTRUMENTS
Entity type:Organization
Organization Name:UP-STATE HEARING INSTRUMENTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:H
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:530-243-7307
Mailing Address - Street 1:1640 TEHAMA ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1617
Mailing Address - Country:US
Mailing Address - Phone:530-243-7307
Mailing Address - Fax:530-243-1292
Practice Address - Street 1:1640 TEHAMA ST
Practice Address - Street 2:SUITE B
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1617
Practice Address - Country:US
Practice Address - Phone:530-243-7307
Practice Address - Fax:530-243-1292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAH.A. 6032237700000X
CAH.A. 1786237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGHA000060Medicaid
CA1841406444OtherNPI #
CA1386845485OtherNPI #