Provider Demographics
NPI:1124386529
Name:KAW VALLEY HEARING LLC
Entity Type:Organization
Organization Name:KAW VALLEY HEARING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:785-856-4200
Mailing Address - Street 1:1520 WAKARUSA DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-1802
Mailing Address - Country:US
Mailing Address - Phone:785-856-4200
Mailing Address - Fax:785-856-4204
Practice Address - Street 1:1520 WAKARUSA DR
Practice Address - Street 2:SUITE B
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-1802
Practice Address - Country:US
Practice Address - Phone:785-856-4200
Practice Address - Fax:785-856-4204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2194305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service