Healthcare Provider Details

I. General information

NPI: 1114144490
Provider Name (Legal Business Name): MEADVILLE HEARING CLINIC II, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1142 S ROGERS ST
CLARKSVILLE AR
72830-9157
US

IV. Provider business mailing address

1142 S ROGERS ST
CLARKSVILLE AR
72830-9157
US

V. Phone/Fax

Practice location:
  • Phone: 479-754-7710
  • Fax: 479-754-8910
Mailing address:
  • Phone: 479-754-7710
  • Fax: 479-754-8910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number420
License Number StateAR

VIII. Authorized Official

Name: MS. VICKI LYNN HOWARD
Title or Position: PRESIDENT
Credential: B.S., B.C.H.I.S.
Phone: 479-754-7710