Provider Demographics
NPI:1437244167
Name:SOUTHWEST HEARING AID CENTER INC
Entity type:Organization
Organization Name:SOUTHWEST HEARING AID CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HENNING
Authorized Official - Suffix:
Authorized Official - Credentials:HEARING AID SPECIALI
Authorized Official - Phone:507-376-4407
Mailing Address - Street 1:907 MCMILLAN ST
Mailing Address - Street 2:PO BOX 275
Mailing Address - City:WORTHINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:56187-2243
Mailing Address - Country:US
Mailing Address - Phone:507-376-4404
Mailing Address - Fax:507-376-6663
Practice Address - Street 1:907 MCMILLAN ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-2243
Practice Address - Country:US
Practice Address - Phone:507-376-4404
Practice Address - Fax:507-376-6663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000694332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment