Healthcare Provider Details

I. General information

NPI: 1396916953
Provider Name (Legal Business Name): WHITMORE HEARING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2008
Last Update Date: 03/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13615 N 35TH AVE STE 4
PHOENIX AZ
85029-1243
US

IV. Provider business mailing address

13615 N 35TH AVE STE 4
PHOENIX AZ
85029-1243
US

V. Phone/Fax

Practice location:
  • Phone: 602-863-7858
  • Fax: 602-863-3715
Mailing address:
  • Phone: 602-863-7858
  • Fax: 602-863-3715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberHAD4302
License Number StateAZ

VIII. Authorized Official

Name: MR. ANDY WHITMORE
Title or Position: HEARING INSTRUMENT SPECIALIST
Credential: HAD
Phone: 602-863-7858