Healthcare Provider Details

I. General information

NPI: 1518514272
Provider Name (Legal Business Name): TRENTON ENGLAND AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4145 S NATIONAL AVE
SPRINGFIELD MO
65807-5356
US

IV. Provider business mailing address

614 WASHINGTON ST STE 101
CHILLICOTHEE MO
64601-2268
US

V. Phone/Fax

Practice location:
  • Phone: 417-815-3229
  • Fax:
Mailing address:
  • Phone: 660-665-9114
  • Fax: 573-756-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number2019026696
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: