Provider Demographics
NPI:1053773416
Name:SIMON AUDIOLOGY & TINNITUS LLC
Entity type:Organization
Organization Name:SIMON AUDIOLOGY & TINNITUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:208-746-7022
Mailing Address - Street 1:PO BOX 851
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-0851
Mailing Address - Country:US
Mailing Address - Phone:208-746-7022
Mailing Address - Fax:208-746-2886
Practice Address - Street 1:1022 BRYDEN AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-5353
Practice Address - Country:US
Practice Address - Phone:208-746-7022
Practice Address - Fax:208-746-2886
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AJA COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2842231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty