Organization Name: | TRI STATE AUDIOLOGY & VESTIBULAR CENTER |
NPI Number: | 1801053046 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LARRY DALE WATERS (OWNER) |
Mailing Address: | 1677 Quartz Cir Bullhead City |
State: | AZ US |
Postal Code: | 864426016 |
Phone Number: | 9287589130 |
Fax Number: | 9287584404 |
NPI Enumeration Date: | 05/16/2008 |
NPI Last Update Date: | 05/16/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332S00000X |
License Number: | DA4586 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
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. |