Healthcare Provider Details

I. General information

NPI: 1023434545
Provider Name (Legal Business Name): THE HEARING AIDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2014
Last Update Date: 03/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 W 19TH ST SUITE A
MOUNTAIN GROVE MO
65711-1287
US

IV. Provider business mailing address

4307 FAIR HAVEN DR
NIXA MO
65714-7339
US

V. Phone/Fax

Practice location:
  • Phone: 417-631-2522
  • Fax:
Mailing address:
  • Phone: 417-631-2522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number2010035283
License Number StateMO

VIII. Authorized Official

Name: JOHN GONZALES IV
Title or Position: DIRECTOR
Credential: H.I.S.
Phone: 417-631-2522