Provider Demographics
NPI:1366724916
Name:DESERT VISTA HEARING LLC
Entity type:Organization
Organization Name:DESERT VISTA HEARING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HAMM
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:520-722-4327
Mailing Address - Street 1:7609 E SPEEDWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-8832
Mailing Address - Country:US
Mailing Address - Phone:520-722-4327
Mailing Address - Fax:520-722-4325
Practice Address - Street 1:7609 E SPEEDWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-8832
Practice Address - Country:US
Practice Address - Phone:520-722-4327
Practice Address - Fax:520-722-4325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBHAD6488237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty