Healthcare Provider Details

I. General information

NPI: 1669806881
Provider Name (Legal Business Name): JEFF SUTTON SCHETTER HAD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2013
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 S RIVER ST STE 1B
HAILEY ID
83333-8436
US

IV. Provider business mailing address

221 S RIVER ST STE 1B
HAILEY ID
83333-8436
US

V. Phone/Fax

Practice location:
  • Phone: 208-788-0296
  • Fax: 208-994-0897
Mailing address:
  • Phone: 208-788-0296
  • Fax: 89-940-8972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number6006
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number5320
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: