Healthcare Provider Details

I. General information

NPI: 1205094257
Provider Name (Legal Business Name): PROFESSIONAL HEARING CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 CONGRESS ST
BELTON MO
64012-2400
US

IV. Provider business mailing address

112 CONGRESS ST
BELTON MO
64012-2400
US

V. Phone/Fax

Practice location:
  • Phone: 816-331-4327
  • Fax: 816-331-4344
Mailing address:
  • Phone: 816-331-4327
  • Fax: 816-331-4344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number2004021609
License Number StateMO

VIII. Authorized Official

Name: DR. KELLY N SPILLER
Title or Position: OWNER/PRESIDENT
Credential: AU.D.
Phone: 816-331-4327