Provider Demographics
NPI:1114144490
Name:MEADVILLE HEARING CLINIC II, INC
Entity Type:Organization
Organization Name:MEADVILLE HEARING CLINIC II, INC
Other - Org Name:MEADVILLE HEARING AIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:BS, BCHIS
Authorized Official - Phone:479-754-7710
Mailing Address - Street 1:1142 S ROGERS ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-9157
Mailing Address - Country:US
Mailing Address - Phone:479-754-7710
Mailing Address - Fax:479-754-8910
Practice Address - Street 1:1142 S ROGERS ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-9157
Practice Address - Country:US
Practice Address - Phone:479-754-7710
Practice Address - Fax:479-754-8910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR420237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR49505OtherBCBS
AR132367766Medicaid