Healthcare Provider Details

I. General information

NPI: 1467602433
Provider Name (Legal Business Name): KS HEALTHLINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4406 E MAIN ST STE 103
MESA AZ
85205-7910
US

IV. Provider business mailing address

4406 E MAIN ST STE 103
MESA AZ
85205-7910
US

V. Phone/Fax

Practice location:
  • Phone: 480-242-6247
  • Fax: 800-682-9127
Mailing address:
  • Phone: 480-242-6247
  • Fax: 800-682-9127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAD4173
License Number StateAZ

VIII. Authorized Official

Name: MR. SCOTT ERIC LINEWEAVER
Title or Position: CEO
Credential: HIS
Phone: 844-432-7483