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General NPI Number Information
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NPI Number | 1285060962
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Entity Type | Organization
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Legal Business Name | CENTRAL STATE SERVICES INC
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Dates
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Enumeration Date | 09/25/2013
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Last Update Date | 09/25/2013
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Provider Practice Location Address
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Address Line | 231 W MAPLE AVE
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City | ENID
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State | OK
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Zip | 73701-4011
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Country | US
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Telephone | 580-242-5555
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Fax | 580-242-5554
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Provider Business Mailing Address
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Address Line | 1606 E WATERMAN ST
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City | WICHITA
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State | KS
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Zip | 67211-1828
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Country | US
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Telephone | 316-613-3989
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Fax | 316-613-3893
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Authorized Official
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Title or Position | CEO
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Name | TIM BRECHEISEN
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Credential | BC-HIS
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Telephone | 316-613-3989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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License Number | 2451
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License Number State | KS
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