Provider Demographics
NPI:1679873046
Name:KEN KIDD INC DBA MIRACLE-EAR
Entity type:Organization
Organization Name:KEN KIDD INC DBA MIRACLE-EAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNTETH
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:KIDD
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:913-498-0909
Mailing Address - Street 1:7410 W 119TH STREET
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213
Mailing Address - Country:US
Mailing Address - Phone:913-498-0909
Mailing Address - Fax:816-942-4302
Practice Address - Street 1:1148 W. 103RD ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114
Practice Address - Country:US
Practice Address - Phone:816-942-4300
Practice Address - Fax:816-942-4302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007008453237700000X
KS1345237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty