Healthcare Provider Details

I. General information

NPI: 1326051079
Provider Name (Legal Business Name): NORTH FLORIDA HEARING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 N PEACOCK AVE
PERRY FL
32347-2117
US

IV. Provider business mailing address

1224 N PEACOCK AVE
PERRY FL
32347-2117
US

V. Phone/Fax

Practice location:
  • Phone: 859-584-3277
  • Fax: 850-584-4738
Mailing address:
  • Phone: 859-584-3277
  • Fax: 850-584-4738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License NumberAY941
License Number StateFL

VIII. Authorized Official

Name: DR. JEFFREY D. RUSSELL
Title or Position: PRESIDENT
Credential: AU.D.
Phone: 850-584-3277