Basic Information
| Provider Information | |||||||||
| NPI: | 1053652917 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CLEARSOUND HEARING LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 904 THOMPSON BLVD | ||||||||
| Address2: | |||||||||
| City: | SEDALIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 653012241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6608263700 | ||||||||
| FaxNumber: | 6608261909 | ||||||||
| Practice Location | |||||||||
| Address1: | 904 THOMPSON BLVD | ||||||||
| Address2: | |||||||||
| City: | SEDALIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 653012241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6608263700 | ||||||||
| FaxNumber: | 6608261909 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2013 | ||||||||
| LastUpdateDate: | 03/01/2013 | ||||||||
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| AuthorizedOfficialLastName: | POTEET | ||||||||
| AuthorizedOfficialFirstName: | JERRY | ||||||||
| AuthorizedOfficialMiddleName: | DALE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5508263700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | HIS | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332S00000X | 2002012707 | MO | Y | Suppliers | Hearing Aid Equipment |
No ID Information.