Healthcare Provider Details

I. General information

NPI: 1578978458
Provider Name (Legal Business Name): VCV HEARING LABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 E AIRPORT RD
SAFFORD AZ
85546-9147
US

IV. Provider business mailing address

1234 E AIRPORT ROAD
SAFFORD AZ
85546
US

V. Phone/Fax

Practice location:
  • Phone: 928-965-4873
  • Fax:
Mailing address:
  • Phone: 928-965-4873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: MRS. DANIELLE VAN SHAAR
Title or Position: ACCOUNTS RECIEVABLE AND PAYABLE
Credential:
Phone: 928-965-4873