Healthcare Provider Details

I. General information

NPI: 1891256053
Provider Name (Legal Business Name): DOVE HEARING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 W MAIN ST
EMMETT ID
83617-2937
US

IV. Provider business mailing address

211 W MAIN ST
EMMETT ID
83617-2937
US

V. Phone/Fax

Practice location:
  • Phone: 208-369-4307
  • Fax: 208-369-4503
Mailing address:
  • Phone: 208-369-4307
  • Fax: 208-369-4503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JULIE KAYE THOMPSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 208-369-4307