=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558728253
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRECISION HEARING AID CENTER, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2016
-----------------------------------------------------
Last Update Date | 01/26/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 129 HORIZON DR
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17517-9634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-435-5694
-----------------------------------------------------
Fax | 717-462-7239
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 129 HORIZON DR
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17517-9634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-435-5694
-----------------------------------------------------
Fax | 717-462-7239
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | ADAM WENTLING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 717-435-5694
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332S00000X
-----------------------------------------------------
Taxonomy Name | Hearing Aid Equipment
-----------------------------------------------------
License Number | F03580
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------