Healthcare Provider Details

I. General information

NPI: 1366138422
Provider Name (Legal Business Name): MAXIMILIAN SIMPSON HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 12/03/2024
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 EAST MAIN STREET
JACKSON OH
45640-2130
US

IV. Provider business mailing address

600 6TH AVENUE
HUNTINGTON WV
25701-2104
US

V. Phone/Fax

Practice location:
  • Phone: 740-286-3656
  • Fax: 513-332-9072
Mailing address:
  • Phone: 304-521-4365
  • Fax: 513-332-9072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number292456
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberIL.03521
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1110
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: