Provider Demographics
NPI:1144886730
Name:LEGACY HEARING CENTER LLC
Entity type:Organization
Organization Name:LEGACY HEARING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEARING AID DISPENSER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CHRISTOPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:HID
Authorized Official - Phone:320-808-0498
Mailing Address - Street 1:507 N NOKOMIS ST STE A
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-2353
Mailing Address - Country:US
Mailing Address - Phone:320-808-0498
Mailing Address - Fax:
Practice Address - Street 1:507 N NOKOMIS ST STE A
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-2353
Practice Address - Country:US
Practice Address - Phone:320-808-0498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty