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General NPI Number Information
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NPI Number | 1700167517
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Entity Type | Organization
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Legal Business Name | ADVANCED FAMILY HEARING AID CENTER, LLC
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Dates
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Enumeration Date | 09/07/2011
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Last Update Date | 09/07/2011
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Provider Practice Location Address
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Address Line | 2027 N DONOVAN AVE STE B
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City | CRYSTAL RIVER
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State | FL
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Zip | 34428-7887
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Country | US
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Telephone | 352-795-1775
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Fax | 352-795-6456
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Provider Business Mailing Address
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Address Line | 2027 N DONOVAN AVE STE B
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City | CRYSTAL RIVER
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State | FL
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Zip | 34428-7887
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Country | US
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Telephone | 352-795-1775
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Fax | 352-795-6456
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Authorized Official
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Title or Position | OWNER/LICENSED HEARING AID SPECIALI
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Name | MS. JERILLYN CLARK
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Credential |
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Telephone | 352-795-1775
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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 |
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License Number State |
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