Provider Demographics
NPI:1366778649
Name:ASTRUM HEARING SOUTH WEST
Entity type:Organization
Organization Name:ASTRUM HEARING SOUTH WEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-253-5007
Mailing Address - Street 1:9640 W TROPICANA AVE STE 116
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-2604
Mailing Address - Country:US
Mailing Address - Phone:702-253-5007
Mailing Address - Fax:
Practice Address - Street 1:9640 W TROPICANA AVE STE 116
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-2604
Practice Address - Country:US
Practice Address - Phone:702-253-5007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVH03000592133384237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty