Healthcare Provider Details

I. General information

NPI: 1518342245
Provider Name (Legal Business Name): MOBILE HEARING OF MISSOURI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2015
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7475 TOM SPARKS RD
DE SOTO MO
63020-5759
US

IV. Provider business mailing address

12910 SHELBYVILLE RD STE 300
LOUISVILLE KY
40243-2404
US

V. Phone/Fax

Practice location:
  • Phone: 855-259-9183
  • Fax: 502-244-2439
Mailing address:
  • Phone: 502-244-2443
  • Fax: 502-244-2439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA MODROSIC
Title or Position: OWNER
Credential: AUD
Phone: 855-259-9183