Provider Demographics
NPI:1124051651
Name:PALM SPRINGS HEARING AID CENTER
Entity type:Organization
Organization Name:PALM SPRINGS HEARING AID CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:HEARING AID DISPENSE
Authorized Official - Phone:760-325-3240
Mailing Address - Street 1:1555 S. PALM CANYON DR.
Mailing Address - Street 2:SUITE D-103
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264
Mailing Address - Country:US
Mailing Address - Phone:760-325-3240
Mailing Address - Fax:760-770-8704
Practice Address - Street 1:1555 S. PALM CANYON DR.
Practice Address - Street 2:SUITE D-103
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264
Practice Address - Country:US
Practice Address - Phone:760-325-3240
Practice Address - Fax:760-770-8704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA2856174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA0028560Medicaid