Provider Demographics
NPI:1487973640
Name:PHILLIPS HEARING CENTER INC.
Entity type:Organization
Organization Name:PHILLIPS HEARING CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEARING INSTRUMENT SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:502-352-2468
Mailing Address - Street 1:103 C. MICHAEL DAVENPORT BLVD.
Mailing Address - Street 2:STE. 2
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601
Mailing Address - Country:US
Mailing Address - Phone:502-352-2468
Mailing Address - Fax:502-352-2472
Practice Address - Street 1:103 C. MICHAEL DAVENPORT BLVD.
Practice Address - Street 2:STE. 2
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601
Practice Address - Country:US
Practice Address - Phone:502-352-2468
Practice Address - Fax:502-352-2472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY0955332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment