Healthcare Provider Details

I. General information

NPI: 1235519679
Provider Name (Legal Business Name): PURE SOUND HEARING CENTERS, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10935 SE 177TH PL 203
SUMMERFIELD FL
34491-8975
US

IV. Provider business mailing address

10935 SE 177TH PL 203
SUMMERFIELD FL
34491-8975
US

V. Phone/Fax

Practice location:
  • Phone: 352-245-2333
  • Fax: 352-245-2338
Mailing address:
  • Phone: 352-245-2333
  • Fax: 352-245-2338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License NumberAS2800
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberAS2800
License Number StateFL

VIII. Authorized Official

Name: MR. AUGUST M ALTOM
Title or Position: OWNER
Credential: BC-HIS
Phone: 352-245-2333