Healthcare Provider Details

I. General information

NPI: 1558443002
Provider Name (Legal Business Name): HEARTLAND HEARING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7710 MERCY RD BERGAN PROFESSIONAL CENTER NORTH, SUITE 322
OMAHA NE
68124-2372
US

IV. Provider business mailing address

7710 MERCY RD BERGAN PROFESSIONAL CENTER NORTH, SUITE 322
OMAHA NE
68124-2372
US

V. Phone/Fax

Practice location:
  • Phone: 402-932-1999
  • Fax: 402-932-1948
Mailing address:
  • Phone: 402-932-1999
  • Fax: 402-932-1948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number21783
License Number StateNE

VIII. Authorized Official

Name: DR. MARK DOUGLAS FREY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 402-932-1999