Provider Demographics
NPI:1659642585
Name:RICHARD POLHILL PROFESSIONAL HEARING SOLUTIONS, LLC
Entity type:Organization
Organization Name:RICHARD POLHILL PROFESSIONAL HEARING SOLUTIONS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:POLHILL
Authorized Official - Suffix:
Authorized Official - Credentials:HAS, BC-HIS
Authorized Official - Phone:386-265-4769
Mailing Address - Street 1:4550 CLYDE MORRIS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-4080
Mailing Address - Country:US
Mailing Address - Phone:386-265-4769
Mailing Address - Fax:386-265-4770
Practice Address - Street 1:4550 CLYDE MORRIS BLVD STE B
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-4080
Practice Address - Country:US
Practice Address - Phone:386-265-4769
Practice Address - Fax:386-265-4770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty