Healthcare Provider Details

I. General information

NPI: 1043695448
Provider Name (Legal Business Name): CHRISTOPHER RICHMOND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S MAIN ST
SIKESTON MO
63801-3034
US

IV. Provider business mailing address

212 S MAIN ST
SIKESTON MO
63801-3034
US

V. Phone/Fax

Practice location:
  • Phone: 573-547-3200
  • Fax: 573-547-3202
Mailing address:
  • Phone: 573-547-3200
  • Fax: 573-547-3202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number2015014524
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: