Provider Demographics
NPI:1568764199
Name:SOUTHERN MISSOURI HEARING SPECIALISTS, LLC
Entity Type:Organization
Organization Name:SOUTHERN MISSOURI HEARING SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HULL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-255-1374
Mailing Address - Street 1:3100 INDEPENDENCE SQ
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-4235
Mailing Address - Country:US
Mailing Address - Phone:417-255-1374
Mailing Address - Fax:417-256-5040
Practice Address - Street 1:3100 INDEPENDENCE SQ
Practice Address - Street 2:SUITE 2
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-4235
Practice Address - Country:US
Practice Address - Phone:417-255-1374
Practice Address - Fax:417-256-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment