Healthcare Provider Details

I. General information

NPI: 1790933786
Provider Name (Legal Business Name): MID MISSOURI AUDIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 W NINTH STREET
SEDALIA MO
65301-5239
US

IV. Provider business mailing address

1706 W NINTH STREET MID MISSOURI HEARING CENTER
SEDALIA MO
65301-5239
US

V. Phone/Fax

Practice location:
  • Phone: 660-826-0180
  • Fax: 660-826-7812
Mailing address:
  • Phone: 660-826-0180
  • Fax: 660-826-7812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: DEBRA LEE GOFFINET
Title or Position: AUDIOLOGIST
Credential: M.A., CCC-A
Phone: 660-826-0180