Provider Demographics
NPI:1407085970
Name:VERSAILLES HEARING LLC
Entity Type:Organization
Organization Name:VERSAILLES HEARING LLC
Other - Org Name:N/A
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:HEARING INSTURMENT SPECIALIST/INTRA
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:HIS/IT
Authorized Official - Phone:573-378-1900
Mailing Address - Street 1:115 W NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:MO
Mailing Address - Zip Code:65084-1039
Mailing Address - Country:US
Mailing Address - Phone:573-378-1900
Mailing Address - Fax:573-378-2190
Practice Address - Street 1:115 W NEWTON ST
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:MO
Practice Address - Zip Code:65084-1039
Practice Address - Country:US
Practice Address - Phone:573-378-1900
Practice Address - Fax:573-378-2190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO389.10OtherHEARING AID PROVIDER UPIN #