Healthcare Provider Details

I. General information

NPI: 1720296676
Provider Name (Legal Business Name): ALEXANDRIA HEARING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 HIGHWAY 29 S SUITE 4055
ALEXANDRIA MN
56308-3486
US

IV. Provider business mailing address

1520 COUNTY ROAD 120 NE
ALEXANDRIA MN
56308-8007
US

V. Phone/Fax

Practice location:
  • Phone: 320-763-2889
  • Fax:
Mailing address:
  • Phone: 320-846-4495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2302
License Number StateMN

VIII. Authorized Official

Name: TOM YAGER
Title or Position: DISPENSER
Credential:
Phone: 320-763-2889