Provider Demographics
NPI:1790929917
Name:PANHANDLE HEARING CENTERS, INC.
Entity Type:Organization
Organization Name:PANHANDLE HEARING CENTERS, INC.
Other - Org Name:MIRACLE EAR
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:NAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-650-6988
Mailing Address - Street 1:662 HARBOR BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2473
Mailing Address - Country:US
Mailing Address - Phone:850-650-6988
Mailing Address - Fax:850-650-6989
Practice Address - Street 1:300 MARY ESTHER BLVD
Practice Address - Street 2:SEARS MIRACLE EAR - SANTA ROSA MALL
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569
Practice Address - Country:US
Practice Address - Phone:850-243-3196
Practice Address - Fax:850-243-8294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS2176237700000X
FLAS4281237700000X
FLAS3760237700000X
FLAS4329237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty