Healthcare Provider Details

I. General information

NPI: 1538601265
Provider Name (Legal Business Name): KILLEAN HEARING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2016
Last Update Date: 11/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 4TH AVE S
CLINTON IA
52732-4311
US

IV. Provider business mailing address

206 4TH AVE S
CLINTON IA
52732-4311
US

V. Phone/Fax

Practice location:
  • Phone: 563-242-7852
  • Fax: 563-242-0452
Mailing address:
  • Phone: 563-242-7852
  • Fax: 563-242-0452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: PIERCE K STARK
Title or Position: PRESIDENT
Credential:
Phone: 563-242-7852