| Organization Name: | SOUTHSIDE HEARING CENTER, LLC |
| NPI Number: | 1043304157 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SUSAN S DEBRUYNE (DOCTOR OF AUDIOLOGY) |
| Mailing Address: | 50 E South St Ste 400a Geneseo |
| State: | NY US |
| Postal Code: | 144541300 |
| Phone Number: | 5852437690 |
| Fax Number: | |
| NPI Enumeration Date: | 10/03/2006 |
| NPI Last Update Date: | 09/17/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332S00000X |
| License Number: | 1451 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Hearing Aid Equipment |
| Taxonomy Specialization: | |
| Taxonomy Definition: | The manufacture and/or sale of electronic hearing aids, their component parts, and related products and services on a national basis. |