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General NPI Number Information
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NPI Number | 1043304157
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Entity Type | Organization
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Legal Business Name | SOUTHSIDE HEARING CENTER, LLC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 3513 THOMAS DR STE 2
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City | LAKEVILLE
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State | NY
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Zip | 14480-9759
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Country | US
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Telephone | 585-243-7690
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Fax | 585-346-7582
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Provider Business Mailing Address
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Address Line | 3513 THOMAS DR STE 2
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City | LAKEVILLE
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State | NY
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Zip | 14480-9759
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Country | US
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Telephone | 585-243-7690
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | KATHLEEN BRADY
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Credential |
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Telephone | 585-243-7690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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License Number | 1451
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License Number State | NY
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Taxonomy #2
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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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