Provider Demographics
NPI:1538870357
Name:FOUR STATES HEARING CENTER LLC
Entity type:Organization
Organization Name:FOUR STATES HEARING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:JR
Authorized Official - Credentials:AUD
Authorized Official - Phone:417-392-0816
Mailing Address - Street 1:1617 W 26TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-0394
Mailing Address - Country:US
Mailing Address - Phone:417-553-2003
Mailing Address - Fax:
Practice Address - Street 1:1617 W 26TH ST STE B
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-0394
Practice Address - Country:US
Practice Address - Phone:417-553-2003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty