Healthcare Provider Details

I. General information

NPI: 1508403601
Provider Name (Legal Business Name): ESCOBAR MOBILE AUD KS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2019
Last Update Date: 12/08/2019
Certification Date: 12/08/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 SW WANAMAKER DR STE 204
TOPEKA KS
66614-4188
US

IV. Provider business mailing address

12910 SHELBYVILLE RD STE 300
LOUISVILLE KY
40243-2404
US

V. Phone/Fax

Practice location:
  • Phone: 502-244-2441
  • Fax:
Mailing address:
  • Phone: 502-244-2441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: JOY STEVENS
Title or Position: DIRECTOR
Credential:
Phone: 502-244-2441