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NPI Code Detail

MEDICARE: EXCEL HEAING CENTER LLC

MEDICARE: EXCEL HEAING CENTER LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1237700000XHearing Instrument Specialist

General Provider Information

NPI Number : 1407668015
Entity Type Code : Organization
Provider Name (Legal Business Name) : EXCEL HEAING CENTER LLC
Provider Business Mailing Address
First Line : 285 W PRAIRIE SHOPPING CTR # 129
Second Line :
City : HAYDEN
State : ID
Zip : 83835-9855
Country : US
Telephone Number : 208-449-6404
Fax Number :
Provider Business Practice Location Address
First Line : 7763 N HEATHGRASS LN
Second Line :
City : COEUR D ALENE
State : ID
Zip : 83815-7969
Country : US
Telephone Number : 208-449-6404
Fax Number :
Authorized Official
Title or Position : REGISTERED AGENT
Name : MR. JEFFREY JAMES BROGAN
Credential : HIS
Telephone Number : 435-592-3347
Provider Enumeration Date : 01/21/2025
Last Update Date : 01/21/2025

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Directions to “EXCEL HEAING CENTER LLC ” Practice Location

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