Provider Demographics
NPI:1487895033
Name:GREAT PLAINS HEARING CENTER
Entity type:Organization
Organization Name:GREAT PLAINS HEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBRE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:DANIELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:580-225-7770
Mailing Address - Street 1:1710 W 3RD ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-5159
Mailing Address - Country:US
Mailing Address - Phone:580-225-7770
Mailing Address - Fax:580-225-2234
Practice Address - Street 1:1710 W 3RD ST
Practice Address - Street 2:SUITE 104
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-5159
Practice Address - Country:US
Practice Address - Phone:580-225-7770
Practice Address - Fax:580-225-2234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK306237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty