Provider Demographics
NPI:1790933786
Name:MID MISSOURI AUDIOLOGY
Entity Type:Organization
Organization Name:MID MISSOURI AUDIOLOGY
Other - Org Name:MID MISSOURI HEARING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GOFFINET
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-A
Authorized Official - Phone:660-826-0180
Mailing Address - Street 1:1706 W NINTH STREET
Mailing Address - Street 2:MID MISSOURI HEARING CENTER
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-5239
Mailing Address - Country:US
Mailing Address - Phone:660-826-0180
Mailing Address - Fax:660-826-7812
Practice Address - Street 1:1706 W NINTH STREET
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-5239
Practice Address - Country:US
Practice Address - Phone:660-826-0180
Practice Address - Fax:660-826-7812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO30329011OtherBLUE CROSS BLUE SHIELD OF KC