1780868307 NPI number — THE HEARING CLINIC

Table of content: (NPI 1780868307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780868307 NPI number — THE HEARING CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE HEARING CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780868307
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 869
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GALESBURG
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61402-0869
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-343-4448
Provider Business Mailing Address Fax Number:
309-343-2107

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
360 E LOSEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GALESBURG
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61401-2843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-343-4448
Provider Business Practice Location Address Fax Number:
309-343-2107
Provider Enumeration Date:
12/18/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HAUSLEIN
Authorized Official First Name:
PETER
Authorized Official Middle Name:
D
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
309-343-9393

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)