MEDICARE: BLACK HILLS AUDIOLOGY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist

General Provider Information

NPI Number	:	1487430518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLACK HILLS AUDIOLOGY LLC

Provider Business Mailing Address
First Line	:	3718 HALL ST
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-2228
Country	:	US
Telephone Number	:	406-600-2458
Fax Number	:

Provider Business Practice Location Address
First Line	:	803 SAINT JOSEPH ST
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-2609
Country	:	US
Telephone Number	:	406-600-2458
Fax Number	:

Authorized Official
Title or Position	:	AUDIOLOGIST, FOUNDER/OWNER
Name	:	DR. JENNIFER DIANE SABERS
Credential	:	AU.D.
Telephone Number	:	406-600-2458

Provider Enumeration Date	:	09/05/2023
Last Update Date	:	09/05/2023

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