Healthcare Provider Details

I. General information

NPI: 1053187294
Provider Name (Legal Business Name): SNAKE RIVER HEARING AND BALANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1582 ELK CREEK DR
IDAHO FALLS ID
83404-8322
US

IV. Provider business mailing address

1582 ELK CREEK DR
IDAHO FALLS ID
83404-8322
US

V. Phone/Fax

Practice location:
  • Phone: 208-542-5414
  • Fax:
Mailing address:
  • Phone: 208-542-5414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name: CRAIG ALLRED
Title or Position: OWNER
Credential: AUD
Phone: 208-542-5414