Provider Demographics
NPI:1780810184
Name:LIFESTYLE HEARING AID CENTER, LC
Entity type:Organization
Organization Name:LIFESTYLE HEARING AID CENTER, LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-625-3366
Mailing Address - Street 1:2221 TAMIAMI TRL
Mailing Address - Street 2:SUITE C
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-2104
Mailing Address - Country:US
Mailing Address - Phone:941-625-3366
Mailing Address - Fax:
Practice Address - Street 1:2221 TAMIAMI TRL
Practice Address - Street 2:SUITE C
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-2104
Practice Address - Country:US
Practice Address - Phone:941-625-3366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies