Healthcare Provider Details

I. General information

NPI: 1710448527
Provider Name (Legal Business Name): BROADMOOR HEARING CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1685 BRIARGATE BLVD STE D
COLORADO SPRINGS CO
80920-3417
US

IV. Provider business mailing address

90 MADISON ST STE 201
DENVER CO
80206-5411
US

V. Phone/Fax

Practice location:
  • Phone: 719-388-1404
  • Fax: 303-355-5879
Mailing address:
  • Phone: 303-322-0054
  • Fax: 303-355-5879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT GARDNER
Title or Position: MANAGER
Credential: AUD
Phone: 303-322-0054