Provider Demographics
NPI:1063964922
Name:HEARTLAND HEARING, INC
Entity type:Organization
Organization Name:HEARTLAND HEARING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEARING INSTRUMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:BRANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-284-4987
Mailing Address - Street 1:2060 W ILES AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-4191
Mailing Address - Country:US
Mailing Address - Phone:636-284-4987
Mailing Address - Fax:
Practice Address - Street 1:2060 W ILES AVE
Practice Address - Street 2:SUITE C
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-4191
Practice Address - Country:US
Practice Address - Phone:636-284-4987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3118237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty