Healthcare Provider Details

I. General information

NPI: 1184897217
Provider Name (Legal Business Name): SHEA HEARING AID CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6133 POPLAR PIKE
MEMPHIS TN
38119-4707
US

IV. Provider business mailing address

6133 POPLAR PIKE
MEMPHIS TN
38119-4707
US

V. Phone/Fax

Practice location:
  • Phone: 901-415-6667
  • Fax: 901-415-6648
Mailing address:
  • Phone: 901-415-6667
  • Fax: 901-415-6648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number0521604
License Number StateTN

VIII. Authorized Official

Name: JOHN J SHEA JR.
Title or Position: CHIEF MEDICAL OFFICER
Credential: M.D.
Phone: 901-761-9720