Basic Information
| Provider Information | |||||||||
| NPI: | 1861829988 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEAR WELL HEARING CARE CENTRE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1221 W SPRESSER ST | ||||||||
| Address2: | |||||||||
| City: | TAYLORVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2178245210 | ||||||||
| FaxNumber: | 2178245211 | ||||||||
| Practice Location | |||||||||
| Address1: | 1221 W SPRESSER ST | ||||||||
| Address2: | |||||||||
| City: | TAYLORVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 625681714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2178245210 | ||||||||
| FaxNumber: | 2178245211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2013 | ||||||||
| LastUpdateDate: | 10/03/2013 | ||||||||
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| AuthorizedOfficialLastName: | BETTIS | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
| AuthorizedOfficialMiddleName: | DENNIS | ||||||||
| AuthorizedOfficialTitleorPosition: | HEARING AIDE SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 2178245210 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | BC-HIS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332S00000X | 1966 | IL | Y | Suppliers | Hearing Aid Equipment |
No ID Information.