Provider Demographics
NPI:1659783322
Name:HEARING CARE CENTERS OF SOUTHERN ILLINOIS
Entity Type:Organization
Organization Name:HEARING CARE CENTERS OF SOUTHERN ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FLESHREN
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:618-960-4763
Mailing Address - Street 1:1480 N GREEN MOUNT RD
Mailing Address - Street 2:STE 200
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-3466
Mailing Address - Country:US
Mailing Address - Phone:618-960-4763
Mailing Address - Fax:
Practice Address - Street 1:1480 N GREEN MOUNT RD
Practice Address - Street 2:STE 200
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-3466
Practice Address - Country:US
Practice Address - Phone:618-960-4763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment