Healthcare Provider Details

I. General information

NPI: 1508100835
Provider Name (Legal Business Name): DERAMUS HEARING AID CENTERA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2012
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 CHESTNUT ST
MONTGOMERY AL
36107-3007
US

IV. Provider business mailing address

2809 CHESTNUT ST
MONTGOMERY AL
36107-3007
US

V. Phone/Fax

Practice location:
  • Phone: 334-262-7553
  • Fax: 334-261-3132
Mailing address:
  • Phone: 334-262-7553
  • Fax: 334-261-3132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1051A
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number4136
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA0593
License Number StateMS
# 5
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number11284
License Number StateAL

VIII. Authorized Official

Name: GLENDA DERAMUS
Title or Position: OWNER
Credential:
Phone: 334-262-7553