=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811120884
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | METATE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2009
-----------------------------------------------------
Last Update Date | 08/25/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 540 MARKS ST
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89014-6654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-898-7315
-----------------------------------------------------
Fax | 702-898-7835
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2349 ROSENDALE VILLAGE AVE
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89052-8731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-363-8524
-----------------------------------------------------
Fax | 702-363-8524
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | MR. ERNEST LEE SCHWENDEMANN
-----------------------------------------------------
Credential | BC-HIS
-----------------------------------------------------
Telephone | 702-898-7315
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332S00000X
-----------------------------------------------------
Taxonomy Name | Hearing Aid Equipment
-----------------------------------------------------
License Number | 204
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------