Healthcare Provider Details

I. General information

NPI: 1881971372
Provider Name (Legal Business Name): ANGEL EARS HEARING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2011
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 LAKEWOOD VILLAGE PL STE D
NORTH LITTLE ROCK AR
72116-8034
US

IV. Provider business mailing address

2600 LAKEWOOD VILLAGE PL STE D
NORTH LITTLE ROCK AR
72116-8034
US

V. Phone/Fax

Practice location:
  • Phone: 615-957-4734
  • Fax:
Mailing address:
  • Phone: 615-957-4734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number601AR
License Number StateAR

VIII. Authorized Official

Name: LINDA MARIE BLOOMFIELD
Title or Position: PRESIDENT
Credential: BC-HIS
Phone: 615-957-4734