Provider Demographics
NPI:1225105976
Name:CHARLES HARE HOLDING CO LLC
Entity Type:Organization
Organization Name:CHARLES HARE HOLDING CO LLC
Other - Org Name:JACKSON COUNTY AUDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:HARE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCCA
Authorized Official - Phone:816-373-7900
Mailing Address - Street 1:17020 E US HIGHWAY 40
Mailing Address - Street 2:SUITE 9
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-5361
Mailing Address - Country:US
Mailing Address - Phone:816-373-7900
Mailing Address - Fax:816-373-7969
Practice Address - Street 1:17020 E US HIGHWAY 40
Practice Address - Street 2:SUITE 9
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-5361
Practice Address - Country:US
Practice Address - Phone:816-373-7900
Practice Address - Fax:816-373-7969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO102183231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO37585023OtherBLUE SHIELD
MO37585023OtherBLUE SHIELD