Provider Demographics
NPI:1841493947
Name:MARYVALE HEARING AID CENTER INC
Entity type:Organization
Organization Name:MARYVALE HEARING AID CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:623-974-1230
Mailing Address - Street 1:11361 N 99TH AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-5469
Mailing Address - Country:US
Mailing Address - Phone:623-974-1230
Mailing Address - Fax:623-974-1821
Practice Address - Street 1:11361 N 99TH AVE STE 105
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-5469
Practice Address - Country:US
Practice Address - Phone:623-974-1230
Practice Address - Fax:623-974-1821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBHAD601237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty