Provider Demographics
NPI:1881946572
Name:MOORE HEARING CLINIC PC
Entity type:Organization
Organization Name:MOORE HEARING CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:641-683-3277
Mailing Address - Street 1:1317 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-1911
Mailing Address - Country:US
Mailing Address - Phone:641-684-7171
Mailing Address - Fax:641-683-3458
Practice Address - Street 1:1317 N COURT ST
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-1911
Practice Address - Country:US
Practice Address - Phone:641-684-7171
Practice Address - Fax:641-683-3458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA291, 122237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty