=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629518543
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLEAR SOUND HEARING CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2017
-----------------------------------------------------
Last Update Date | 02/24/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4521 S STATE ROUTE 159 STE 2
-----------------------------------------------------
City | GLEN CARBON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62034-1577
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-531-9610
-----------------------------------------------------
Fax | 618-205-1110
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4521 S STATE ROUTE 159 STE 2
-----------------------------------------------------
City | GLEN CARBON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62034-1577
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-531-9610
-----------------------------------------------------
Fax | 618-205-1110
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. COLLEEN E OVERSTREET
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 618-531-9610
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | 0889
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------