Healthcare Provider Details

I. General information

NPI: 1194020883
Provider Name (Legal Business Name): PHILLIPS HEARING AID CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2011
Last Update Date: 02/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 HUDSON LN SUITE 1-C
MONROE LA
71201-6045
US

IV. Provider business mailing address

1101 HUDSON LN SUITE 1-C
MONROE LA
71201-6045
US

V. Phone/Fax

Practice location:
  • Phone: 318-325-2363
  • Fax: 318-325-2361
Mailing address:
  • Phone: 318-325-2363
  • Fax: 318-325-2361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberLA-680
License Number StateLA

VIII. Authorized Official

Name: MR. LARRY COLLUM
Title or Position: MANAGER
Credential:
Phone: 318-325-2363