MEDICARE: MEADVILLE HEARING CLINIC II, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	420	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	49505	OTHER	AR	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114144490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEADVILLE HEARING CLINIC II, INC

Provider Business Mailing Address
First Line	:	1142 S ROGERS ST
Second Line	:
City	:	CLARKSVILLE
State	:	AR
Zip	:	72830-9157
Country	:	US
Telephone Number	:	479-754-7710
Fax Number	:	479-754-8910

Provider Business Practice Location Address
First Line	:	1142 S ROGERS ST
Second Line	:
City	:	CLARKSVILLE
State	:	AR
Zip	:	72830-9157
Country	:	US
Telephone Number	:	479-754-7710
Fax Number	:	479-754-8910

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. VICKI LYNN HOWARD
Credential	:	B.S., B.C.H.I.S.
Telephone Number	:	479-754-7710

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	04/04/2017

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