Organization
PRAIRIE SEA HEARING CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAY RAISEN MD (PHYSICIAN)
(701) 805-8057
Entity
Organization
Contact information
Practice address
3000 N 14TH ST STE 3C, BISMARCK, ND 58503-0697
(701) 805-8057
(701) 751-3168
Mailing address
3000 N 14TH ST STE 3C, BISMARCK, ND 58503-0697
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
—
—
237600000X
Audiologist-Hearing Aid Fitter
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1477988459
—
ND
05
—
1790216844
—
ND
Enumeration date
10/20/2020
Last updated
12/10/2020
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