Healthcare Provider Details

I. General information

NPI: 1447470158
Provider Name (Legal Business Name): IMAGINEARS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 HAWTHORNE ST
MEDFORD OR
97504-7114
US

IV. Provider business mailing address

1401 UPPER APPLEGATE RD
JACKSONVILLE OR
97530-9179
US

V. Phone/Fax

Practice location:
  • Phone: 541-776-3461
  • Fax: 541-776-0482
Mailing address:
  • Phone: 541-899-2007
  • Fax: 541-776-0482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number22174
License Number StateOR

VIII. Authorized Official

Name: MRS. ELIZABETH D TANGEL
Title or Position: AUDIOLOGIST
Credential: MSCCCA
Phone: 541-776-3461