Provider Demographics
NPI:1376911768
Name:MOBILE HEARING OF KANSAS LLC
Entity Type:Organization
Organization Name:MOBILE HEARING OF KANSAS LLC
Other - Org Name:SPECIAL CARE HEARING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:CAVENEE
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:855-259-9183
Mailing Address - Street 1:12910 SHELBYVILLE RD
Mailing Address - Street 2:STE 300
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1593
Mailing Address - Country:US
Mailing Address - Phone:855-259-9183
Mailing Address - Fax:502-254-4069
Practice Address - Street 1:300 S AZTEC ST
Practice Address - Street 2:
Practice Address - City:MONTEZUMA
Practice Address - State:KS
Practice Address - Zip Code:67867-8811
Practice Address - Country:US
Practice Address - Phone:620-846-2241
Practice Address - Fax:620-846-2149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-02
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201131680AMedicaid
KSKA3720Medicare PIN