Healthcare Provider Details

I. General information

NPI: 1174044283
Provider Name (Legal Business Name): SPARKS HEARING AND BALANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 PULLMAN DR
SPARKS NV
89434-7921
US

IV. Provider business mailing address

1441 PULLMAN DR
SPARKS NV
89434-7921
US

V. Phone/Fax

Practice location:
  • Phone: 775-336-0211
  • Fax: 775-336-0213
Mailing address:
  • Phone: 775-336-0211
  • Fax: 775-336-0213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SCOTT SUMRALL
Title or Position: AUDIOLOGIST/OWNER
Credential: AU.D.
Phone: 775-336-0211