Healthcare Provider Details

I. General information

NPI: 1174711378
Provider Name (Legal Business Name): SOUTHWEST AUDIOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2007
Last Update Date: 04/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 E. INDIAN SCHOOL RD. #120
PHOENIX AZ
85016
US

IV. Provider business mailing address

3104 E. INDIAN SCHOOL ROAD #120
PHOENIX AZ
85016
US

V. Phone/Fax

Practice location:
  • Phone: 602-224-5981
  • Fax:
Mailing address:
  • Phone: 602-224-5981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number993
License Number StateAZ

VIII. Authorized Official

Name: MS. CHERYL A RUNGE
Title or Position: PRESIDENT
Credential: M.S.
Phone: 602-224-5970