Healthcare Provider Details

I. General information

NPI: 1245873314
Provider Name (Legal Business Name): HEARTLAND HEARING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 WASHINGTONST
CHLLICOTHE MO
64601
US

IV. Provider business mailing address

202 W COLUMBIA ST
FARMINGTON MO
63640
US

V. Phone/Fax

Practice location:
  • Phone: 660-240-5111
  • Fax: 573-616-2999
Mailing address:
  • Phone: 573-756-0555
  • Fax: 573-756-0556

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: KELLI R KERNAN
Title or Position: OPERATIONS MANAGER
Credential: BC-HIS
Phone: 573-756-0555