Provider Demographics
NPI:1528503810
Name:GEORGE E. WIDHSON, LLC
Entity type:Organization
Organization Name:GEORGE E. WIDHSON, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEARING INSTRUMENT SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WIDHSON
Authorized Official - Suffix:III
Authorized Official - Credentials:HIS
Authorized Official - Phone:215-379-2256
Mailing Address - Street 1:611 HUNTINGDON PIKE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROCKLEDGE
Mailing Address - State:PA
Mailing Address - Zip Code:19046-4456
Mailing Address - Country:US
Mailing Address - Phone:215-379-2256
Mailing Address - Fax:215-379-2331
Practice Address - Street 1:611 HUNTINGDON PIKE
Practice Address - Street 2:SUITE A
Practice Address - City:ROCKLEDGE
Practice Address - State:PA
Practice Address - Zip Code:19046-4456
Practice Address - Country:US
Practice Address - Phone:215-379-2256
Practice Address - Fax:215-379-2331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF002505332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014008850001Medicaid