Provider Demographics
NPI:1063768042
Name:MATHENY HEARING SERVICES
Entity type:Organization
Organization Name:MATHENY HEARING SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MATHENY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-258-6166
Mailing Address - Street 1:7463 SHADOWWOOD CT NE
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-7853
Mailing Address - Country:US
Mailing Address - Phone:541-258-6166
Mailing Address - Fax:
Practice Address - Street 1:7463 SHADOWWOOD CT NE
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-7853
Practice Address - Country:US
Practice Address - Phone:541-258-6166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHAS-P-165880237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty