Healthcare Provider Details

I. General information

NPI: 1801063409
Provider Name (Legal Business Name): MT. ZION HEARING AID CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101A E ASHLAND AVE
MT ZION IL
62549-1272
US

IV. Provider business mailing address

101A E ASHLAND AVE
MT ZION IL
62549-1272
US

V. Phone/Fax

Practice location:
  • Phone: 217-864-4327
  • Fax: 217-864-0878
Mailing address:
  • Phone: 217-864-4327
  • Fax: 217-864-0878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberIL2776
License Number StateIL

VIII. Authorized Official

Name: MRS. BARBARA ROSE MOODY
Title or Position: HEARING INSTRUMENT SPECIALIST
Credential: HIS
Phone: 217-864-4327