Healthcare Provider Details

I. General information

NPI: 1841744893
Provider Name (Legal Business Name): HEARING AID INSTITUTE OF KALISPELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 08/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 1ST AVE E
KALISPELL MT
59901-5801
US

IV. Provider business mailing address

1305 1ST AVE E
KALISPELL MT
59901-5801
US

V. Phone/Fax

Practice location:
  • Phone: 406-755-1945
  • Fax: 406-341-4528
Mailing address:
  • Phone: 406-755-1945
  • Fax: 406-314-4528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number235
License Number StateMT

VIII. Authorized Official

Name: MIKE R VAN DE RIET
Title or Position: OWNER
Credential: HAD
Phone: 406-755-1945