Basic Information
| Provider Information | |||||||||
| NPI: | 1801063409 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MT. ZION HEARING AID CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101A E ASHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | MT ZION | ||||||||
| State: | IL | ||||||||
| PostalCode: | 625491272 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2178644327 | ||||||||
| FaxNumber: | 2178640878 | ||||||||
| Practice Location | |||||||||
| Address1: | 101A E ASHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | MT ZION | ||||||||
| State: | IL | ||||||||
| PostalCode: | 625491272 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2178644327 | ||||||||
| FaxNumber: | 2178640878 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2008 | ||||||||
| LastUpdateDate: | 05/13/2008 | ||||||||
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| AuthorizedOfficialLastName: | MOODY | ||||||||
| AuthorizedOfficialFirstName: | BARBARA | ||||||||
| AuthorizedOfficialMiddleName: | ROSE | ||||||||
| AuthorizedOfficialTitleorPosition: | HEARING INSTRUMENT SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 2178644327 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | HIS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | IL2776 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.