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General NPI Number Information
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NPI Number | 1437244167
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Entity Type | Organization
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Legal Business Name | SOUTHWEST HEARING AID CENTER INC
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 907 MCMILLAN ST
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City | WORTHINGTON
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State | MN
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Zip | 56187-2243
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Country | US
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Telephone | 507-376-4404
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Fax | 507-376-6663
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Provider Business Mailing Address
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Address Line | 907 MCMILLAN ST PO BOX 275
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City | WORTHINGTON
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State | MN
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Zip | 56187-2243
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Country | US
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Telephone | 507-376-4404
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Fax | 507-376-6663
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MRS. GLAD HENNING
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Credential | HEARING AID SPECIALI
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Telephone | 507-376-4407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 000694
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License Number State | IA
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