Provider Demographics
NPI:1679648885
Name:GREENVILLE HEARING CENTER, INC.
Entity Type:Organization
Organization Name:GREENVILLE HEARING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:AUD, CCC-A
Authorized Official - Phone:618-664-1146
Mailing Address - Street 1:310 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62246-1733
Mailing Address - Country:US
Mailing Address - Phone:618-664-1146
Mailing Address - Fax:618-664-4576
Practice Address - Street 1:310 S 3RD ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:IL
Practice Address - Zip Code:62246-1733
Practice Address - Country:US
Practice Address - Phone:618-664-1146
Practice Address - Fax:618-664-4576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147-00177231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL478224OtherHEALTHLINK INSURANCE
IL0000332001OtherBLUECROSS BLUESHIELD INS.
IL355522908001Medicaid
IL4500135OtherUNITED HEALTHCARE
IL0000332001OtherBLUECROSS BLUESHIELD INS.