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General NPI Number Information
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NPI Number | 1477979540
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Entity Type | Organization
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Legal Business Name | HEARING AID SERVICE LLC
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Dates
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Enumeration Date | 03/12/2014
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Last Update Date | 03/12/2014
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Provider Practice Location Address
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Address Line | 107 E HIGH ST
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City | POTOSI
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State | MO
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Zip | 63664-1906
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Country | US
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Telephone | 573-766-5206
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Fax | 574-256-0244
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Provider Business Mailing Address
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Address Line | PO BOX 65
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City | BELGRADE
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State | MO
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Zip | 63622-0065
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Country | US
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Telephone | 573-766-5206
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Fax | 574-256-0244
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Authorized Official
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Title or Position | MEMBER
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Name | MR. COLIN RUSSELL
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Credential | NBC-HIS
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Telephone | 573-766-5206
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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 | 2013019352
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License Number State | MO
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