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General NPI Number Information
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NPI Number | 1134475882
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Entity Type | Organization
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Legal Business Name | GULF COAST HEARING AID CENTERS INC.
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Dates
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Enumeration Date | 07/31/2012
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Last Update Date | 07/31/2012
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Provider Practice Location Address
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Address Line | 1441 TAMIAMI TRAIL #491
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City | PORT CHARLOTTE
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State | FL
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Zip | 33948
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Country | US
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Telephone | 941-255-1234
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Fax | 941-255-1047
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Provider Business Mailing Address
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Address Line | 10315 RIVERBANK TERRACE
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City | BRADENTON
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State | FL
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Zip | 34212
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Country | US
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Telephone | 941-708-6996
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Fax | 941-708-6997
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Authorized Official
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Title or Position | OWNER
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Name | MRS. VICTORIA LYNN WAGNER
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Credential |
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Telephone | 941-708-6996
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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 | AS913
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License Number State | FL
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