Provider Demographics
NPI:1659636686
Name:SOUTHWEST KANSAS MIRACLE-EAR
Entity Type:Organization
Organization Name:SOUTHWEST KANSAS MIRACLE-EAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEARING CONSULTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-271-0013
Mailing Address - Street 1:2310 E KANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-6959
Mailing Address - Country:US
Mailing Address - Phone:620-271-0013
Mailing Address - Fax:
Practice Address - Street 1:2310 E KANSAS AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-6959
Practice Address - Country:US
Practice Address - Phone:620-271-0013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty