Healthcare Provider Details

I. General information

NPI: 1790929917
Provider Name (Legal Business Name): PANHANDLE HEARING CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2009
Last Update Date: 05/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MARY ESTHER BLVD SEARS MIRACLE EAR - SANTA ROSA MALL
MARY ESTHER FL
32569
US

IV. Provider business mailing address

662 HARBOR BLVD SUITE 140
DESTIN FL
32541-2473
US

V. Phone/Fax

Practice location:
  • Phone: 850-243-3196
  • Fax: 850-243-8294
Mailing address:
  • Phone: 850-650-6988
  • Fax: 850-650-6989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS2176
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS4281
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS4329
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS3760
License Number StateFL

VIII. Authorized Official

Name: MS. NAN B HICKS
Title or Position: PRESIDENT
Credential:
Phone: 850-650-6988