Healthcare Provider Details

I. General information

NPI: 1083121156
Provider Name (Legal Business Name): JOSEPH BURT HAS HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 E MAIN ST
LANCASTER OH
43130-3903
US

IV. Provider business mailing address

433 POWDER MILL LN
COLUMBUS OH
43228-1233
US

V. Phone/Fax

Practice location:
  • Phone: 740-654-4327
  • Fax: 740-654-4327
Mailing address:
  • Phone: 614-620-2733
  • Fax: 740-654-4327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberIL02360
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: