Healthcare Provider Details

I. General information

NPI: 1306242342
Provider Name (Legal Business Name): ROGER OBERMEIER HEARING SPECIALIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2014
Last Update Date: 11/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S SMITH ST
SMITHTON IL
62285-1724
US

IV. Provider business mailing address

210 S. SMITH ST
SMITHTON IL
62285
US

V. Phone/Fax

Practice location:
  • Phone: 816-877-4921
  • Fax:
Mailing address:
  • Phone: 816-877-4921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1129
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number0827
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1606
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: