Provider Demographics
NPI:1780832733
Name:HEARING DOCTORS OF NORTH AMERICA LLC
Entity Type:Organization
Organization Name:HEARING DOCTORS OF NORTH AMERICA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:L
Authorized Official - Last Name:GILLUM
Authorized Official - Suffix:JR
Authorized Official - Credentials:AUD
Authorized Official - Phone:785-537-4005
Mailing Address - Street 1:1213 HYLTON HEIGHTS RD
Mailing Address - Street 2:STE 105
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2810
Mailing Address - Country:US
Mailing Address - Phone:785-537-4005
Mailing Address - Fax:785-537-0196
Practice Address - Street 1:1213 HYLTON HEIGHTS RD
Practice Address - Street 2:STE 105
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2810
Practice Address - Country:US
Practice Address - Phone:785-537-4005
Practice Address - Fax:785-537-0196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS939231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100227700BMedicaid
KS100227700BMedicaid