Healthcare Provider Details

I. General information

NPI: 1811053531
Provider Name (Legal Business Name): ROCKY MOUNTAIN HEARING AID CO OF MT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 1ST AVE W
KALISPELL MT
59901-4444
US

IV. Provider business mailing address

240 1ST AVE W
KALISPELL MT
59901-4444
US

V. Phone/Fax

Practice location:
  • Phone: 406-755-5077
  • Fax: 406-755-5995
Mailing address:
  • Phone: 406-755-5077
  • Fax: 406-755-5995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number122
License Number StateMT

VIII. Authorized Official

Name: BYRON RANDALL
Title or Position: OWNER
Credential: BC-HIS
Phone: 406-755-5077