Provider Demographics
NPI:1285706598
Name:WELLS HEARING AID CENTER INC
Entity type:Organization
Organization Name:WELLS HEARING AID CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, VP, SECRETARY, DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:HEARING AID FITTER
Authorized Official - Phone:402-393-6633
Mailing Address - Street 1:6846 PACIFIC ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-1156
Mailing Address - Country:US
Mailing Address - Phone:402-393-6633
Mailing Address - Fax:402-553-5125
Practice Address - Street 1:6846 PACIFIC ST
Practice Address - Street 2:SUITE 102
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-1156
Practice Address - Country:US
Practice Address - Phone:402-393-6633
Practice Address - Fax:402-553-5125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE626237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE82-00310Medicaid
NE626OtherLICENSE HA FITTER-DISP.
NE=========-00Medicaid