MEDICARE: SOUTHWEST KANSAS MIRACLE-EAR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist		KS

General Provider Information

NPI Number	:	1659636686
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST KANSAS MIRACLE-EAR

Provider Business Mailing Address
First Line	:	2310 E KANSAS AVE
Second Line	:
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-6959
Country	:	US
Telephone Number	:	620-271-0013
Fax Number	:

Provider Business Practice Location Address
First Line	:	2310 E KANSAS AVE
Second Line	:
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-6959
Country	:	US
Telephone Number	:	620-271-0013
Fax Number	:

Authorized Official
Title or Position	:	HEARING CONSULTANT
Name	:	MR. TOM HARMON
Credential	:
Telephone Number	:	620-271-0013

Provider Enumeration Date	:	07/05/2012
Last Update Date	:	07/05/2012

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