Healthcare Provider Details

I. General information

NPI: 1861789570
Provider Name (Legal Business Name): HEARING SOLUTIONS OF PEORIA, IL, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 N MAIN ST TOWN CENTER II
EAST PEORIA IL
61611-2543
US

IV. Provider business mailing address

129 N MAIN ST TOWN CENTER II
EAST PEORIA IL
61611-2543
US

V. Phone/Fax

Practice location:
  • Phone: 309-698-3300
  • Fax:
Mailing address:
  • Phone: 309-698-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1772
License Number StateIL

VIII. Authorized Official

Name: MICHAEL R ROONEY
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 309-698-3300