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General NPI Number Information
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NPI Number | 1245788769
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Entity Type | Organization
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Legal Business Name | SAM'S CLUB HEARING CENTER
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Dates
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Enumeration Date | 09/13/2016
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Last Update Date | 09/13/2016
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Provider Practice Location Address
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Address Line | 7050 WATTS RD
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City | MADISON
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State | WI
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Zip | 53719-1365
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Country | US
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Telephone | 608-287-3455
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Fax |
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Provider Business Mailing Address
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Address Line | 7050 WATTS RD
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City | MADISON
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State | WI
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Zip | 53719-1365
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Country | US
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Telephone | 608-287-3455
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Fax |
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Authorized Official
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Title or Position | HEARING PRACTITIONER
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Name | MELISSA THOMAS
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Credential | HIS
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Telephone | 608-287-3455
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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 | 1463-60
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License Number State | WI
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