Healthcare Provider Details

I. General information

NPI: 1588108286
Provider Name (Legal Business Name): MOORE HEARING, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2016
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 THREE MILE DR
KALISPELL MT
59901-3034
US

IV. Provider business mailing address

10 THREE MILE DR
KALISPELL MT
59901-3034
US

V. Phone/Fax

Practice location:
  • Phone: 406-253-6752
  • Fax:
Mailing address:
  • Phone: 406-253-6752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD795
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License NumberAUD795
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License NumberAUD795
License Number StateMT
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberHAD4054
License Number StateMT
# 5
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAD387
License Number StateMT
# 6
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAD1291
License Number StateMT
# 7
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAUD795
License Number StateMT

VIII. Authorized Official

Name: DR. STACIA MOORE
Title or Position: OWNER
Credential: AU.D.
Phone: 406-253-6752