Provider Demographics
NPI:1972822690
Name:MCRAY-DENTON HEARING AID CENTER
Entity type:Organization
Organization Name:MCRAY-DENTON HEARING AID CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR./HEARING AID SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MANGUS
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC, HIS
Authorized Official - Phone:405-222-5555
Mailing Address - Street 1:428 W GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-5865
Mailing Address - Country:US
Mailing Address - Phone:405-222-5555
Mailing Address - Fax:405-222-2028
Practice Address - Street 1:428 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-5865
Practice Address - Country:US
Practice Address - Phone:405-222-5555
Practice Address - Fax:405-222-2028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK679237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty