Provider Demographics
NPI:1710107354
Name:ADVANCED HEARING CARE PC
Entity Type:Organization
Organization Name:ADVANCED HEARING CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:918-333-9992
Mailing Address - Street 1:4100 SE ADAMS RD
Mailing Address - Street 2:SUITE C106
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-8437
Mailing Address - Country:US
Mailing Address - Phone:918-333-9992
Mailing Address - Fax:918-333-9996
Practice Address - Street 1:4100 SE ADAMS RD
Practice Address - Street 2:SUITE C106
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-8437
Practice Address - Country:US
Practice Address - Phone:918-333-9992
Practice Address - Fax:918-333-9996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK190231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200095630BMedicaid