Healthcare Provider Details

I. General information

NPI: 1942836499
Provider Name (Legal Business Name): BABIES FIRST NEWBORN HEARING SCREEN PROGRAM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 03/17/2020
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18321 MONROVIA ST
BUCYRUS KS
66013-4523
US

IV. Provider business mailing address

18321 MONROVIA ST
BUCYRUS KS
66013-4523
US

V. Phone/Fax

Practice location:
  • Phone: 602-909-3673
  • Fax:
Mailing address:
  • Phone: 602-909-3673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: JASON MUNSON
Title or Position: PRESIDENT
Credential:
Phone: 602-909-3673