Healthcare Provider Details

I. General information

NPI: 1578751558
Provider Name (Legal Business Name): AMERICAN EAR HEARING & AUDIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 N. 21ST STREET
NEWARK OH
43055
US

IV. Provider business mailing address

905 N. 21ST STREET
NEWARK OH
43055
US

V. Phone/Fax

Practice location:
  • Phone: 740-344-4412
  • Fax: 740-364-0199
Mailing address:
  • Phone: 740-344-4412
  • Fax: 740-364-0199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberCERT. # 007310
License Number StateOH

VIII. Authorized Official

Name: DELTA LEE SIRLES
Title or Position: CORPORATE MANAGER
Credential:
Phone: 740-344-4412