Provider Demographics
NPI:1174730683
Name:ADVANCED HEARING AID CENTER, INC
Entity type:Organization
Organization Name:ADVANCED HEARING AID CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GIMBEL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-A
Authorized Official - Phone:509-835-3999
Mailing Address - Street 1:933 W 3RD AVE SUITE 104
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-4522
Mailing Address - Country:US
Mailing Address - Phone:509-835-3999
Mailing Address - Fax:509-835-3998
Practice Address - Street 1:933 W 3RD AVE SUITE 104
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-4500
Practice Address - Country:US
Practice Address - Phone:509-835-3999
Practice Address - Fax:509-835-3998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA619332S00000X
WA237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9050675Medicaid
WA129786OtherLABOR AND INDUSTRIES