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General NPI Number Information
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NPI Number | 1013036169
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Entity Type | Organization
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Legal Business Name | SOUTH IDAHO HEARING & AUDIOLOGY
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 10/22/2009
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Provider Practice Location Address
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Address Line | 1330 FILER AVE E
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City | TWIN FALLS
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State | ID
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Zip | 83301-4119
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Country | US
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Telephone | 208-734-4555
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Fax | 208-734-3632
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Provider Business Mailing Address
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Address Line | 112 SEMINOLE CIRLCE
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City | JEROME
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State | ID
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Zip | 83338
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Country | US
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Telephone | 208-324-4414
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANDREW JOSEPH SEITZ
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Credential |
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Telephone | 208-734-4555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State |
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