Healthcare Provider Details

I. General information

NPI: 1801618699
Provider Name (Legal Business Name): MID AMERICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 S WESTERN AVE
LIBERAL KS
67901-3569
US

IV. Provider business mailing address

21 S WESTERN AVE
LIBERAL KS
67901-3569
US

V. Phone/Fax

Practice location:
  • Phone: 620-626-6356
  • Fax:
Mailing address:
  • Phone: 620-626-6356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY INGRAM
Title or Position: OWNERE
Credential:
Phone: 806-440-3781