Provider Demographics
NPI:1124060561
Name:AUDIOLOGY & HEARING CENTER OF FARMINGTON, INC
Entity type:Organization
Organization Name:AUDIOLOGY & HEARING CENTER OF FARMINGTON, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:573-756-0500
Mailing Address - Street 1:620 WALTON DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-1935
Mailing Address - Country:US
Mailing Address - Phone:573-756-0500
Mailing Address - Fax:573-756-0505
Practice Address - Street 1:620 WALTON DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1935
Practice Address - Country:US
Practice Address - Phone:573-756-0500
Practice Address - Fax:573-756-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO113484237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO45-00144OtherUHC
MO193973OtherBCBS
MO7035519OtherAETNA
MO338885437Medicaid
MO621859OtherHEALTHLINK
MO621859OtherHEALTHLINK
MO338885437Medicaid
MO=========OtherGM