Provider Demographics
NPI:1164629812
Name:MITCH AND CHRIS STANDARD INC.
Entity Type:Organization
Organization Name:MITCH AND CHRIS STANDARD INC.
Other - Org Name:MACOMB AUDIOLOGY AND HEARING AID CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:STANDARD
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:309-836-2836
Mailing Address - Street 1:515 E GRANT ST STE 114
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-4510
Mailing Address - Country:US
Mailing Address - Phone:309-836-5031
Mailing Address - Fax:
Practice Address - Street 1:515 E GRANT ST STE 114
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-4510
Practice Address - Country:US
Practice Address - Phone:309-836-5031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147-000837231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL278708668001Medicaid
IL212993Medicare ID - Type UnspecifiedCORPORATE
IL278708668001Medicaid