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General NPI Number Information
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NPI Number | 1497265870
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Entity Type | Organization
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Legal Business Name | MIDSTATE HEARING INC.
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Dates
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Enumeration Date | 10/11/2017
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Last Update Date | 10/11/2017
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Provider Practice Location Address
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Address Line | 3801 GE RD STE 1
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City | BLOOMINGTON
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State | IL
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Zip | 61704-4193
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Country | US
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Telephone | 309-662-9552
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Fax |
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Provider Business Mailing Address
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Address Line | 3801 GE RD STE 1
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City | BLOOMINGTON
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State | IL
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Zip | 61704-4193
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Country | US
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Telephone | 309-662-9552
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Fax |
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Authorized Official
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Title or Position | SPECIALIST
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Name | KYLE MCCLINTOCK
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Credential | HIS
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Telephone | 309-685-0887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number |
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License Number State |
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