Provider Demographics
NPI:1629212832
Name:HEARING CENTERS OF THE PANHANDLE, INC.
Entity Type:Organization
Organization Name:HEARING CENTERS OF THE PANHANDLE, INC.
Other - Org Name:MIRACLE EAR
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:NAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-650-6988
Mailing Address - Street 1:662 HARBOR BLVD
Mailing Address - Street 2:SUITE 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 1:798 DOWNTOWNER BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-5424
Practice Address - Country:US
Practice Address - Phone:251-316-0960
Practice Address - Fax:251-316-0970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-01
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4134237700000X
AL2199237700000X
AL2177237700000X
AL4153237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty