Healthcare Provider Details

I. General information

NPI: 1952307191
Provider Name (Legal Business Name): SELECT HEARING AID CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 W DIVISION ST STE 115
SAINT CLOUD MN
56301-4548
US

IV. Provider business mailing address

3333 W DIVISION ST STE 115
SAINT CLOUD MN
56301-4548
US

V. Phone/Fax

Practice location:
  • Phone: 320-252-1341
  • Fax: 320-252-1383
Mailing address:
  • Phone: 320-252-1341
  • Fax: 320-252-1383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number2011
License Number StateMN

VIII. Authorized Official

Name: MR. GEORGE CHARLES SIMMONS
Title or Position: OWNER
Credential: BC-HIS
Phone: 320-252-1341