Healthcare Provider Details

I. General information

NPI: 1710427786
Provider Name (Legal Business Name): METATE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2017
Last Update Date: 02/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 S EASTERN AVE SUITE 215
HENDERSON NV
89052-6201
US

IV. Provider business mailing address

2349 ROSENDALE VILLAGE AVE
HENDERSON NV
89052-8731
US

V. Phone/Fax

Practice location:
  • Phone: 702-405-6955
  • Fax: 702-405-6956
Mailing address:
  • Phone: 702-363-8524
  • Fax: 702-363-8524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number204
License Number StateNV

VIII. Authorized Official

Name: MR. ERNEST LEE SCHWENDEMANN
Title or Position: OWNER/HIS
Credential: BC-HIS
Phone: 702-405-6955