Provider Demographics
NPI:1114298403
Name:HEARTLAND HEARING AID CENTER
Entity Type:Organization
Organization Name:HEARTLAND HEARING AID CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISPENSER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:G
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:580-767-1961
Mailing Address - Street 1:1209 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-2843
Mailing Address - Country:US
Mailing Address - Phone:580-767-1961
Mailing Address - Fax:580-767-0749
Practice Address - Street 1:1209 N 7TH ST
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-2843
Practice Address - Country:US
Practice Address - Phone:580-767-1961
Practice Address - Fax:580-767-0749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK541332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment