Healthcare Provider Details

I. General information

NPI: 1770978140
Provider Name (Legal Business Name): LIFESOUNDS HEARING AIDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 W TWINCOURT TRL SUITE 604
ST AUGUSTINE FL
32095-8805
US

IV. Provider business mailing address

559 W TWINCOURT TRL SUITE 604
ST AUGUSTINE FL
32095-8805
US

V. Phone/Fax

Practice location:
  • Phone: 904-940-1211
  • Fax: 904-940-4532
Mailing address:
  • Phone: 904-940-1211
  • Fax: 904-940-4532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberME62420
License Number StateFL

VIII. Authorized Official

Name: MRS. JODI S GREEN
Title or Position: OFFICE MANAGER
Credential: MA, CCC-A
Phone: 904-446-9191