Healthcare Provider Details

I. General information

NPI: 1497265870
Provider Name (Legal Business Name): MIDSTATE HEARING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 10/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 GE RD STE 1
BLOOMINGTON IL
61704-4193
US

IV. Provider business mailing address

3801 GE RD STE 1
BLOOMINGTON IL
61704-4193
US

V. Phone/Fax

Practice location:
  • Phone: 309-662-9552
  • Fax:
Mailing address:
  • Phone: 309-662-9552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: KYLE MCCLINTOCK
Title or Position: SPECIALIST
Credential: HIS
Phone: 309-685-0887