Provider Demographics
NPI:1164891875
Name:CERTIFIED AUDIOLOGY DISTRIBUTION, LLC
Entity Type:Organization
Organization Name:CERTIFIED AUDIOLOGY DISTRIBUTION, LLC
Other - Org Name:PRISTINE HEARING AID SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KERBY
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-687-5421
Mailing Address - Street 1:13610 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64145-1670
Mailing Address - Country:US
Mailing Address - Phone:913-278-1200
Mailing Address - Fax:816-943-6364
Practice Address - Street 1:13610 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64145-1670
Practice Address - Country:US
Practice Address - Phone:913-278-1200
Practice Address - Fax:816-943-6364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1567332S00000X
MO2012011481332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment