Matthew David Black, H.I.S.
Individual provider Active NPI Hearing Instrument Specialist · Idaho Falls, ID
NPI 1639718745 · NPPES record last updated Jan 6, 2020
Key facts
- NPI
- 1639718745
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Hearing Instrument Specialist 237700000X
- License
- HA3634 (ID)
- Practice address
- 3656 Washington Pkwy
Idaho Falls, ID 83404-7573 - Phone
- (208) 529-4969
- NPI assigned
- Jan 6, 2020
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| HA3634 | ID | MD | Hearing Instrument Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| My Hearing Centers, LLC | Hearing Instrument Specialist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hearing Instrument Specialist | 237700000X | HA3634 | ID | Yes |
Addresses
Primary practice location
3656 Washington Pkwy
Idaho Falls, ID 83404-7573
Mailing address
3656 Washington Pkwy
Idaho Falls, ID 83404-7573
Phone (208) 529-4969
Other providers in Idaho Falls, ID
- Kelli M Bishop
- Matthew Allen Bishop
- Raelene Ann Bishop
- Bruce N Bjornson
- Joshua Phillip Black
- Richard Wayne Black
- Timothy Roger Black
- James Rex Blackburn
- Shandra Blacker
- Cory Blad
All providers in Idaho Falls, ID · Hearing Instrument Specialist in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 6, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.