=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184908998
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NICHOLAS E OLDHAM LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2011
-----------------------------------------------------
Last Update Date | 05/01/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1220 E SLOAN ST.
-----------------------------------------------------
City | HARRISBURG
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62946-2716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-253-3277
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1220 E SLOAN ST
-----------------------------------------------------
City | HARRISBURG
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62946-2716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-253-3277
-----------------------------------------------------
Fax | 618-253-8060
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | NICHOLAS E OLDHAM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 618-253-3277
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237600000X
-----------------------------------------------------
Taxonomy Name | Audiologist-Hearing Aid Fitter
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------