Provider Demographics
NPI:1801934567
Name:KILLEAN AUDIOLOGY & HEARING AID CTRS
Entity type:Organization
Organization Name:KILLEAN AUDIOLOGY & HEARING AID CTRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISPENSER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:STARK
Authorized Official - Suffix:
Authorized Official - Credentials:NBC HIS
Authorized Official - Phone:563-242-7852
Mailing Address - Street 1:206 4TH AVE S
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732
Mailing Address - Country:US
Mailing Address - Phone:563-242-7852
Mailing Address - Fax:563-242-0452
Practice Address - Street 1:1601 52ND AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265
Practice Address - Country:US
Practice Address - Phone:309-762-6467
Practice Address - Fax:309-762-7218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0093153Medicaid
IA0184481Medicaid