Provider Demographics
NPI:1174756167
Name:MOUNTAIN VIEW HEARING AID CENTER LLC
Entity type:Organization
Organization Name:MOUNTAIN VIEW HEARING AID CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:KEESEE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:360-681-4481
Mailing Address - Street 1:PO BOX 3445
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-5029
Mailing Address - Country:US
Mailing Address - Phone:360-681-4481
Mailing Address - Fax:
Practice Address - Street 1:625 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-5062
Practice Address - Country:US
Practice Address - Phone:360-681-4481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA2054332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9045501Medicaid