Healthcare Provider Details

I. General information

NPI: 1659568111
Provider Name (Legal Business Name): AMERICAN HEARING AID LABS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 W RIVERSIDE BLVD
ROCKFORD IL
61103-2195
US

IV. Provider business mailing address

1090 W RIVERSIDE BLVD
ROCKFORD IL
61103-2195
US

V. Phone/Fax

Practice location:
  • Phone: 815-877-8600
  • Fax: 815-877-0661
Mailing address:
  • Phone: 815-877-8600
  • Fax: 815-877-0661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number24086649
License Number StateIL

VIII. Authorized Official

Name: TIMOTHY F CONLEY
Title or Position: OWNER
Credential: NBC HIS
Phone: 815-877-8600