Healthcare Provider Details

I. General information

NPI: 1962714915
Provider Name (Legal Business Name): GRAHAM HEARING AID SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2010
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 LEXINGTON AVE
FORT SMITH AR
72901-4945
US

IV. Provider business mailing address

1005 LEXINGTON AVE
FORT SMITH AR
72901-4945
US

V. Phone/Fax

Practice location:
  • Phone: 479-783-5250
  • Fax: 479-782-9629
Mailing address:
  • Phone: 479-783-5250
  • Fax: 479-782-9629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number391
License Number StateAR

VIII. Authorized Official

Name: MR. JERRY DEAN RICHARDS
Title or Position: G.M.
Credential: BC-HIS, ACA
Phone: 479-783-5250