Provider Demographics
NPI:1134419492
Name:COLUMBIA HEARING CENTER
Entity type:Organization
Organization Name:COLUMBIA HEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NORTHUP
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:573-875-4327
Mailing Address - Street 1:1306 OLD HIGHWAY 63 S
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8404
Mailing Address - Country:US
Mailing Address - Phone:573-875-4327
Mailing Address - Fax:573-442-4502
Practice Address - Street 1:1306 OLD HIGHWAY 63 S
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8404
Practice Address - Country:US
Practice Address - Phone:573-875-4327
Practice Address - Fax:573-442-4502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20088000047237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty