Provider Demographics
NPI:1881968097
Name:WILLMAR HEARING AID CENTER
Entity type:Organization
Organization Name:WILLMAR HEARING AID CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MEINDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-235-7244
Mailing Address - Street 1:925 W VILLARD ST
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-4843
Mailing Address - Country:US
Mailing Address - Phone:701-227-4403
Mailing Address - Fax:701-483-4405
Practice Address - Street 1:925 W VILLARD ST
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-4843
Practice Address - Country:US
Practice Address - Phone:701-227-4403
Practice Address - Fax:701-483-4405
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRAIRIE HEARING CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDH-0313237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty