Provider Demographics
NPI:1447470158
Name:IMAGINEARS, INC.
Entity type:Organization
Organization Name:IMAGINEARS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:D
Authorized Official - Last Name:TANGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MSCCCA
Authorized Official - Phone:541-776-3461
Mailing Address - Street 1:1401 UPPER APPLEGATE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97530-9179
Mailing Address - Country:US
Mailing Address - Phone:541-899-2007
Mailing Address - Fax:541-776-0482
Practice Address - Street 1:42 HAWTHORNE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7114
Practice Address - Country:US
Practice Address - Phone:541-776-3461
Practice Address - Fax:541-776-0482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22174237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR226610Medicaid
OR226610Medicaid