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General NPI Number Information
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NPI Number | 1154678894
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Entity Type | Organization
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Legal Business Name | MAHASKA HEARING AID CENTER
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Dates
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Enumeration Date | 08/13/2012
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Last Update Date | 08/13/2012
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Provider Practice Location Address
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Address Line | 714 A AVE W
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City | OSKALOOSA
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State | IA
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Zip | 52577-2032
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Country | US
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Telephone | 641-673-5643
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Fax | 641-673-5643
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Provider Business Mailing Address
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Address Line | 714 A AVE W
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City | OSKALOOSA
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State | IA
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Zip | 52577-2032
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Country | US
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Telephone | 641-673-5643
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Fax | 641-673-5643
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Authorized Official
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Title or Position | OWNER
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Name | LOREN A MARTIN
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Credential | PHD
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Telephone | 19095768050
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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 | 00491
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License Number State | IA
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