Provider Demographics
NPI:1356749154
Name:HEAR-MART, LLC
Entity type:Organization
Organization Name:HEAR-MART, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-782-8318
Mailing Address - Street 1:9142 SHENANDOAH RUN
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-5455
Mailing Address - Country:US
Mailing Address - Phone:815-782-8318
Mailing Address - Fax:815-782-8397
Practice Address - Street 1:2295 ESSINGTON RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-1654
Practice Address - Country:US
Practice Address - Phone:815-782-8318
Practice Address - Fax:815-782-8397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment