Healthcare Provider Details

I. General information

NPI: 1679873046
Provider Name (Legal Business Name): KEN KIDD INC DBA MIRACLE-EAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1148 W. 103RD ST
KANSAS CITY MO
64114
US

IV. Provider business mailing address

7410 W 119TH STREET
OVERLAND PARK KS
66213
US

V. Phone/Fax

Practice location:
  • Phone: 816-942-4300
  • Fax: 816-942-4302
Mailing address:
  • Phone: 913-498-0909
  • Fax: 816-942-4302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1345
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2007008453
License Number StateMO

VIII. Authorized Official

Name: MR. KENNTETH WAYNE KIDD
Title or Position: OWNER
Credential: H.I.S.
Phone: 913-498-0909