Provider Demographics
NPI:1952961690
Name:PRESCOTT VALLEY HEARING, LLC
Entity Type:Organization
Organization Name:PRESCOTT VALLEY HEARING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNKER
Authorized Official - Suffix:
Authorized Official - Credentials:HAD, BC-HIS
Authorized Official - Phone:435-773-1877
Mailing Address - Street 1:3108 CLEARWATER DR STE B2
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7170
Mailing Address - Country:US
Mailing Address - Phone:928-460-4035
Mailing Address - Fax:
Practice Address - Street 1:3108 CLEARWATER DR STE B2
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7170
Practice Address - Country:US
Practice Address - Phone:928-460-4035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty