1255850418 NPI number — LEGACY HEARING INCORPORATED

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255850418 NPI number — LEGACY HEARING INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEGACY HEARING INCORPORATED
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:
LOWRY HEARING AID CENTERS
Provider Other Organization Name Type Code:
3
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:
1255850418
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2640 E 32ND ST STE 11
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOPLIN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64804-4311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-553-0724
Provider Business Mailing Address Fax Number:
417-553-3478

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2640 E 32ND ST STE 11
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOPLIN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64804-4311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-553-0724
Provider Business Practice Location Address Fax Number:
417-553-3478
Provider Enumeration Date:
09/19/2017

Additional Information

Authorized Official

Authorized Official Last Name:
RINK
Authorized Official First Name:
BILL
Authorized Official Middle Name:
BRODY
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
417-553-0724

Provider Taxonomy Codes

  • Taxonomy code: 237700000X , with the licence number:  2015039402 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 237700000X , with the licence number: 001105 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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