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General NPI Number Information
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NPI Number | 1083914238
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Entity Type | Organization
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Legal Business Name | PALM BAY HEARING AID CENTER
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Dates
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Enumeration Date | 10/21/2010
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Last Update Date | 10/21/2010
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Provider Practice Location Address
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Address Line | 754 MALABAR RD SE
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City | PALM BAY
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State | FL
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Zip | 32907
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Country | US
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Telephone | 321-369-9900
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Fax |
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Provider Business Mailing Address
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Address Line | 754 MALABAR RD SE
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City | PALM BAY
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State | FL
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Zip | 32907
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Country | US
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Telephone | 321-369-9900
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOHN ROBERTS
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Credential | BC-HIS HAS
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Telephone | 321-369-9900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 11-00017112
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License Number State | FL
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