Provider Demographics
NPI:1275721508
Name:FLORIDA STATE HEARING AIDS INC
Entity type:Organization
Organization Name:FLORIDA STATE HEARING AIDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:FL LHAS HIS AS2626
Authorized Official - Phone:386-226-0007
Mailing Address - Street 1:1808 WEST INTERNATIONAL SPEEDWAY BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-1227
Mailing Address - Country:US
Mailing Address - Phone:386-226-0007
Mailing Address - Fax:386-226-3037
Practice Address - Street 1:1808 WEST INTERNATIONAL SPEEDWAY BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1227
Practice Address - Country:US
Practice Address - Phone:386-226-0007
Practice Address - Fax:386-226-3037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS2626237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJ8134OtherBLUE CROSS BLUE SHIELD