Provider Demographics
NPI:1609034669
Name:PANHANDLE HEARING INC
Entity Type:Organization
Organization Name:PANHANDLE HEARING INC
Other - Org Name:SEARS MIRACLE-EAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEARING INSTRUMENT SPECIALIST/VP
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:R
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:850-243-3196
Mailing Address - Street 1:662 HIGHWAY 98 E
Mailing Address - Street 2:STE 140
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2473
Mailing Address - Country:US
Mailing Address - Phone:850-650-6988
Mailing Address - Fax:850-650-6989
Practice Address - Street 1:300 MARY ESTHER BLVD
Practice Address - Street 2:
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569-1693
Practice Address - Country:US
Practice Address - Phone:850-243-3196
Practice Address - Fax:850-243-8294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL270010706883251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare