Healthcare Provider Details

I. General information

NPI: 1487024337
Provider Name (Legal Business Name): FREEDOM MOBILE HEARING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 N COUNTY ROAD 25 E
BELLVUE CO
80512-5922
US

IV. Provider business mailing address

3100 N COUNTY ROAD 25 E
BELLVUE CO
80512-5922
US

V. Phone/Fax

Practice location:
  • Phone: 970-217-7087
  • Fax:
Mailing address:
  • Phone: 970-217-7087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number572
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CHRISTINE RUSSELL
Title or Position: OWNER
Credential: AU.D.
Phone: 970-217-7087