Basic Information
| Provider Information | |||||||||
| NPI: | 1164696746 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAPE GIRARDEAU AUDIOLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 S MOUNT AUBURN RD | ||||||||
| Address2: | SUITE 420 | ||||||||
| City: | CAPE GIRARDEAU | ||||||||
| State: | MO | ||||||||
| PostalCode: | 637034911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733354448 | ||||||||
| FaxNumber: | 5733354466 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 S MOUNT AUBURN RD | ||||||||
| Address2: | SUITE 420 | ||||||||
| City: | CAPE GIRARDEAU | ||||||||
| State: | MO | ||||||||
| PostalCode: | 637034911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733354448 | ||||||||
| FaxNumber: | 5733354466 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2008 | ||||||||
| LastUpdateDate: | 04/15/2008 | ||||||||
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| AuthorizedOfficialLastName: | COONCE | ||||||||
| AuthorizedOfficialFirstName: | DON | ||||||||
| AuthorizedOfficialMiddleName: | CURTIS | ||||||||
| AuthorizedOfficialTitleorPosition: | OTOLARYNGOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 5733354448 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SEMO OTOLARYNGOLOGY | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.