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General NPI Number Information
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NPI Number | 1770978140
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Entity Type | Organization
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Legal Business Name | LIFESOUNDS HEARING AIDS
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Dates
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Enumeration Date | 04/02/2015
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Last Update Date | 04/02/2015
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Provider Practice Location Address
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Address Line | 559 W TWINCOURT TRL SUITE 604
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City | ST AUGUSTINE
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State | FL
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Zip | 32095-8805
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Country | US
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Telephone | 904-940-1211
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Fax | 904-940-4532
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Provider Business Mailing Address
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Address Line | 559 W TWINCOURT TRL SUITE 604
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City | ST AUGUSTINE
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State | FL
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Zip | 32095-8805
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Country | US
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Telephone | 904-940-1211
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Fax | 904-940-4532
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JODI S GREEN
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Credential | MA, CCC-A
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Telephone | 904-446-9191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | ME62420
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License Number State | FL
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