Provider Demographics
NPI:1902009905
Name:THE AUDIOLOGY CENTER,LLC
Entity Type:Organization
Organization Name:THE AUDIOLOGY CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR OF AUDIOLOGY
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:573-651-3404
Mailing Address - Street 1:262 S MOUNT AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-4918
Mailing Address - Country:US
Mailing Address - Phone:573-651-3404
Mailing Address - Fax:573-651-0035
Practice Address - Street 1:262 S MOUNT AUBURN RD
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4918
Practice Address - Country:US
Practice Address - Phone:573-651-3404
Practice Address - Fax:573-651-0035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01168 & 102600231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO504578600Medicaid
MO000024235OtherMEDICARE PROVIDER TRANSACTION ACCESS NUMBER FOR CATHY L WILLEN
MO000024236OtherMEDICARE PROVIDER TRANSACTION ACCESS NUMBER FOR STEVE BROWN
MO000024235OtherMEDICARE PROVIDER TRANSACTION ACCESS NUMBER FOR CATHY L WILLEN
MO000024236OtherMEDICARE PROVIDER TRANSACTION ACCESS NUMBER FOR STEVE BROWN