Healthcare Provider Details

I. General information

NPI: 1992243562
Provider Name (Legal Business Name): MIDWEST MEDICAL HEARING CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3526 OSBORNE LN SUITE D
LAFAYETTE IN
47909-3998
US

IV. Provider business mailing address

3526 OSBORNE LN SUITE D
LAFAYETTE IN
47909-3998
US

V. Phone/Fax

Practice location:
  • Phone: 765-471-2111
  • Fax: 765-471-2112
Mailing address:
  • Phone: 765-471-2111
  • Fax: 765-471-2112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number17001329A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number17001329A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number17001329A
License Number StateIN

VIII. Authorized Official

Name: MR. CHARLEY CASH
Title or Position: PRESIDENT
Credential: BC-HIS
Phone: 317-402-6578