Healthcare Provider Details

I. General information

NPI: 1770369183
Provider Name (Legal Business Name): BISMARCK HEARING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2023
Last Update Date: 09/01/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3831 LOCKPORT ST STE C
BISMARCK ND
58503-5539
US

IV. Provider business mailing address

3831 LOCKPORT ST STE C
BISMARCK ND
58503-5539
US

V. Phone/Fax

Practice location:
  • Phone: 701-751-2500
  • Fax: 701-751-0231
Mailing address:
  • Phone: 701-751-2500
  • Fax: 701-751-0231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: DR. SHELLY M GROSSMAN
Title or Position: PRESIDENT
Credential: AUD
Phone: 701-391-6951