Basic Information
| Provider Information | |||||||||
| NPI: | 1225159577 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROFESSIONAL HEARING CTR PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 415 E 23RD ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | FREMONT | ||||||||
| State: | NE | ||||||||
| PostalCode: | 680252393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027218960 | ||||||||
| FaxNumber: | 4027217988 | ||||||||
| Practice Location | |||||||||
| Address1: | 415 E 23RD ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | FREMONT | ||||||||
| State: | NE | ||||||||
| PostalCode: | 680252393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027218960 | ||||||||
| FaxNumber: | 4027217988 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MCKNIGHT | ||||||||
| AuthorizedOfficialFirstName: | EVELYN | ||||||||
| AuthorizedOfficialMiddleName: | V | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER AUDIOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 4027218690 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | AUD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | 49 | NE | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.