Healthcare Provider Details

I. General information

NPI: 1679915821
Provider Name (Legal Business Name): HEARTLAND HEARING CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 W COLUMBIA ST
FARMINGTON MO
63640-1705
US

IV. Provider business mailing address

202 W COLUMBIA ST
FARMINGTON MO
63640-1705
US

V. Phone/Fax

Practice location:
  • Phone: 573-756-0555
  • Fax: 573-756-0556
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 Number2009008392
License Number StateMO

VIII. Authorized Official

Name: KELLI KERNAN
Title or Position: HEARING INSTRUMENT SPECIALIST
Credential:
Phone: 573-756-0555