Healthcare Provider Details

I. General information

NPI: 1134206550
Provider Name (Legal Business Name): SPRINGFIELD HEARING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E WOODHURST DR BUILDING Q, SUITE 100
SPRINGFIELD MO
65804-4257
US

IV. Provider business mailing address

1200 E WOODHURST DR BUILDING Q, SUITE 100
SPRINGFIELD MO
65804-4257
US

V. Phone/Fax

Practice location:
  • Phone: 417-881-1010
  • Fax: 417-887-4327
Mailing address:
  • Phone: 417-881-1010
  • Fax: 417-887-4327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. PRESTON ESTES
Title or Position: AUDIOLOGIST / DIRECTOR
Credential: MS, CCC-A
Phone: 417-881-1010