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General NPI Number Information
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NPI Number | 1457801946
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Entity Type | Organization
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Legal Business Name | AUDIO HEARING CENTER
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Dates
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Enumeration Date | 10/07/2016
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Last Update Date | 10/07/2016
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Provider Practice Location Address
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Address Line | 1306 BROADWAY ST
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City | MOUNT VERNON
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State | IL
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Zip | 62864-3717
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Country | US
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Telephone | 618-242-1126
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Fax | 618-242-5296
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Provider Business Mailing Address
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Address Line | 1306 BROADWAY ST
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City | MOUNT VERNON
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State | IL
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Zip | 62864-3717
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Country | US
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Telephone | 618-242-1126
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Fax | 618-242-5296
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Authorized Official
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Title or Position | HEARING INSTRUMENT SPECIALIST
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Name | MR. MARTIN JAY STEPHENS
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Credential | BC-HIS
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Telephone | 618-242-1126
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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 | 2234
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License Number State | IL
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