Provider Demographics
NPI:1801166152
Name:MANAN HEARING LLC
Entity type:Organization
Organization Name:MANAN HEARING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPECIALIST (HIS)
Authorized Official - Prefix:MR
Authorized Official - First Name:L.
Authorized Official - Middle Name:BAKER
Authorized Official - Last Name:SHEPLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:HIS
Authorized Official - Phone:314-757-5619
Mailing Address - Street 1:426 BROOKTREE DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2743
Mailing Address - Country:US
Mailing Address - Phone:314-757-5619
Mailing Address - Fax:
Practice Address - Street 1:426 BROOKTREE DR
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-2743
Practice Address - Country:US
Practice Address - Phone:314-757-5619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006006561237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty