Provider Demographics
NPI:1659405132
Name:BELLA VISTA HEARING CENTER PLLC
Entity Type:Organization
Organization Name:BELLA VISTA HEARING CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-254-0011
Mailing Address - Street 1:22 SUGAR CREEK CENTER
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72714
Mailing Address - Country:US
Mailing Address - Phone:479-876-0110
Mailing Address - Fax:479-876-0111
Practice Address - Street 1:22 SUGAR CREEK CENTER
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72714
Practice Address - Country:US
Practice Address - Phone:479-876-0110
Practice Address - Fax:479-876-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA206231H00000X, 332S00000X
231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F515Medicare ID - Type Unspecified