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General NPI Number Information
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NPI Number | 1629418801
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL PROVIDERS INC.
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Dates
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Enumeration Date | 07/02/2013
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Last Update Date | 07/02/2013
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Provider Practice Location Address
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Address Line | 1027 S MAIN ST STE 307
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City | JOPLIN
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State | MO
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Zip | 64801-4527
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Country | US
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Telephone | 417-623-8486
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Fax | 417-623-3551
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Provider Business Mailing Address
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Address Line | 1027 S MAIN ST STE 307
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City | JOPLIN
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State | MO
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Zip | 64801-4527
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Country | US
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Telephone | 417-623-8486
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Fax | 417-623-3551
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Authorized Official
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Title or Position | OWNER
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Name | HOMER WOODSON MILLER
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Credential | BC-HIS
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Telephone | 417-623-8486
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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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