Healthcare Provider Details

I. General information

NPI: 1770254674
Provider Name (Legal Business Name): PREMIER HEARING AIDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 N YORK ST
MUSKOGEE OK
74403-3135
US

IV. Provider business mailing address

1006 N YORK ST
MUSKOGEE OK
74403-3135
US

V. Phone/Fax

Practice location:
  • Phone: 918-694-5270
  • Fax: 918-912-2029
Mailing address:
  • Phone: 918-694-5270
  • Fax: 918-912-2029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RONNIE BUTTRESS
Title or Position: OWNER
Credential: BC-HIS
Phone: 918-694-5270