Healthcare Provider Details

I. General information

NPI: 1467135111
Provider Name (Legal Business Name): DALE HURST HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23420 LORAIN RD
NORTH OLMSTED OH
44070-2272
US

IV. Provider business mailing address

23420 LORAIN RD
NORTH OLMSTED OH
44070-2272
US

V. Phone/Fax

Practice location:
  • Phone: 440-979-1863
  • Fax:
Mailing address:
  • Phone: 440-979-1863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberIL.03434
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: