=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134669740
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMANUELE HEARING HEALTHCARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2017
-----------------------------------------------------
Last Update Date | 03/01/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6783 VETERANS PKWY 300 BLDG 4
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31909-3254
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-576-9888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3949 MULLENHURST DR
-----------------------------------------------------
City | PALM HARBOR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34685-3666
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-424-3121
-----------------------------------------------------
Fax | 727-934-9197
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AMBR/PRESIDENT
-----------------------------------------------------
Name | MR. JOHN EMANUELE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 727-424-3121
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332S00000X
-----------------------------------------------------
Taxonomy Name | Hearing Aid Equipment
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------