Provider Demographics
NPI:1629418801
Name:PROFESSIONAL PROVIDERS INC.
Entity Type:Organization
Organization Name:PROFESSIONAL PROVIDERS INC.
Other - Org Name:JOPLIN HEARING AID CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOMER
Authorized Official - Middle Name:WOODSON
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:417-623-8486
Mailing Address - Street 1:1027 S MAIN ST
Mailing Address - Street 2:STE 307
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-4527
Mailing Address - Country:US
Mailing Address - Phone:417-623-8486
Mailing Address - Fax:417-623-3551
Practice Address - Street 1:1027 S MAIN ST
Practice Address - Street 2:STE 307
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-4527
Practice Address - Country:US
Practice Address - Phone:417-623-8486
Practice Address - Fax:417-623-3551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty