Provider Demographics
NPI:1720228760
Name:STILLWATER HEARING CLINIC, INC.
Entity Type:Organization
Organization Name:STILLWATER HEARING CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:A
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, FAAA
Authorized Official - Phone:405-624-8605
Mailing Address - Street 1:116 W 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4602
Mailing Address - Country:US
Mailing Address - Phone:405-624-8605
Mailing Address - Fax:405-624-8606
Practice Address - Street 1:116 W 8TH AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4602
Practice Address - Country:US
Practice Address - Phone:405-624-8605
Practice Address - Fax:405-624-8606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center