Provider Demographics
NPI:1710182258
Name:WILLMAR HEARING AID CENTER INC
Entity Type:Organization
Organization Name:WILLMAR HEARING AID CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MEINDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-276-0277
Mailing Address - Street 1:1604 1ST ST S
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-4243
Mailing Address - Country:US
Mailing Address - Phone:320-235-7244
Mailing Address - Fax:320-235-3153
Practice Address - Street 1:1604 1ST ST S
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-4243
Practice Address - Country:US
Practice Address - Phone:320-235-7244
Practice Address - Fax:320-235-3153
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRAIRIE HEARING CLINIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-15
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC02842Medicare ID - Type Unspecified