Provider Demographics
NPI:1063818268
Name:BRAGG FAMILY HEARING AID CENTER, LLC
Entity type:Organization
Organization Name:BRAGG FAMILY HEARING AID CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, HEARING AID SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:TOM
Authorized Official - Last Name:BRAGG
Authorized Official - Suffix:JR
Authorized Official - Credentials:LHIS
Authorized Official - Phone:405-751-2552
Mailing Address - Street 1:2222 W HEFNER RD STE K
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGE
Mailing Address - State:OK
Mailing Address - Zip Code:73120-7619
Mailing Address - Country:US
Mailing Address - Phone:405-751-2552
Mailing Address - Fax:
Practice Address - Street 1:2222 W HEFNER RD STE K
Practice Address - Street 2:
Practice Address - City:THE VILLAGE
Practice Address - State:OK
Practice Address - Zip Code:73120-7619
Practice Address - Country:US
Practice Address - Phone:405-751-2552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-15
Last Update Date:2014-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1067261QH0700X, 332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech