Healthcare Provider Details

I. General information

NPI: 1366778649
Provider Name (Legal Business Name): ASTRUM HEARING SOUTH WEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2009
Last Update Date: 10/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9640 W TROPICANA AVE STE 116
LAS VEGAS NV
89147-2604
US

IV. Provider business mailing address

9640 W TROPICANA AVE STE 116
LAS VEGAS NV
89147-2604
US

V. Phone/Fax

Practice location:
  • Phone: 702-253-5007
  • Fax:
Mailing address:
  • Phone: 702-253-5007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberH03000592133384
License Number StateNV

VIII. Authorized Official

Name: DAVID BENSON
Title or Position: OWNER
Credential:
Phone: 702-253-5007