=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518320134
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN VASH H.I.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2016
-----------------------------------------------------
Last Update Date | 05/06/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 162 MIDDLETOWN RD
-----------------------------------------------------
City | FAIRMONT
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26554-8104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-210-8118
-----------------------------------------------------
Fax | 304-842-1060
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 449 VALLEY VIEW RD
-----------------------------------------------------
City | BRIDGEPORT
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26330-7259
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-476-7503
-----------------------------------------------------
Fax | 304-842-1060
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | 950
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------