Provider Demographics
NPI:1790817021
Name:HDN SHEPPARD ACQUISITION INC.
Entity type:Organization
Organization Name:HDN SHEPPARD ACQUISITION INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHEPPARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-323-6129
Mailing Address - Street 1:1905 W NORTH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-2956
Mailing Address - Country:US
Mailing Address - Phone:937-323-6129
Mailing Address - Fax:937-323-6770
Practice Address - Street 1:1905 W NORTH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-2956
Practice Address - Country:US
Practice Address - Phone:937-323-6129
Practice Address - Fax:937-323-6770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA0327231H00000X
OH02601237600000X
OHA01389237600000X
OHA01460237600000X
OHA0306237600000X
OH01339237700000X
OH02306237700000X
OH02216237700000X
OH02263237700000X
OH02728237700000X
OH02409237700000X
OH00525237700000X
OH02232237700000X
OH02299237700000X
OH01774237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Not Answered237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0584612Medicaid
OH000000197953OtherAUDIOLOGY & DME
OH4500003OtherAUDIOLOGY & DME
OH4500003OtherAUDIOLOGY & DME
OH=========002OtherAUDIOLOGY & DME