Healthcare Provider Details

I. General information

NPI: 1245477934
Provider Name (Legal Business Name): COVENANT AUDIOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2009
Last Update Date: 01/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S 24TH ST W
BILLINGS MT
59102-5600
US

IV. Provider business mailing address

111 S 24TH ST W
BILLINGS MT
59102-5600
US

V. Phone/Fax

Practice location:
  • Phone: 406-656-2003
  • Fax:
Mailing address:
  • Phone: 406-656-2003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number252
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number160
License Number StateMT

VIII. Authorized Official

Name: DR. GENE W. BUKOWSKI
Title or Position: OWNER
Credential: AU.D.
Phone: 406-656-2003