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General NPI Number Information
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NPI Number | 1801618699
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Entity Type | Organization
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Legal Business Name | MID AMERICA
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Dates
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Enumeration Date | 10/31/2024
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 21 S WESTERN AVE
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City | LIBERAL
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State | KS
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Zip | 67901-3569
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Country | US
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Telephone | 620-626-6356
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Fax |
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Provider Business Mailing Address
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Address Line | 21 S WESTERN AVE
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City | LIBERAL
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State | KS
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Zip | 67901-3569
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Country | US
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Telephone | 620-626-6356
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Fax |
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Authorized Official
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Title or Position | OWNERE
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Name | MR. TIMOTHY INGRAM
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Credential |
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Telephone | 806-440-3781
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number |
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License Number State |
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