Healthcare Provider Details

I. General information

NPI: 1376978320
Provider Name (Legal Business Name): HEARTLAND HEARING CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 TELEGRAPH RD SUITE 106
SAINT LOUIS MO
63129-3399
US

IV. Provider business mailing address

202 W COLUMBIA ST
FARMINGTON MO
63640-1705
US

V. Phone/Fax

Practice location:
  • Phone: 314-487-5550
  • Fax: 314-487-5554
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 KERNAN
Title or Position: HEARING INSTRUMENT SPECIALIST
Credential:
Phone: 573-756-0555