Provider Demographics
NPI:1063897874
Name:ADVANCE HEARING AID CENTER LLC
Entity type:Organization
Organization Name:ADVANCE HEARING AID CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER HEARING INSTRUMENT SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SYNTHIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:POTUZNIK
Authorized Official - Suffix:
Authorized Official - Credentials:HEARING INSTR SPEC
Authorized Official - Phone:608-362-2669
Mailing Address - Street 1:1327 TOWNLINE AVE
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-4168
Mailing Address - Country:US
Mailing Address - Phone:608-362-2669
Mailing Address - Fax:608-362-2669
Practice Address - Street 1:1327 TOWNLINE AVE
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-4168
Practice Address - Country:US
Practice Address - Phone:608-362-2669
Practice Address - Fax:608-362-2669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI86460237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1174882245OtherINDIVIDUAL NAME NPI NUMBER ASSIGNED
WI864 60OtherCERTIFIED HEARING INSTRUMENT SPECIALIST