Healthcare Provider Details

I. General information

NPI: 1588953640
Provider Name (Legal Business Name): AUDIOLOGY AND HEARING CENTER OF GRAND ISLAND PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 06/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 N DIERS AVE SUITE 4
GRAND ISLAND NE
68803-4977
US

IV. Provider business mailing address

527 N DIERS AVE SUITE 4
GRAND ISLAND NE
68803-4977
US

V. Phone/Fax

Practice location:
  • Phone: 308-382-4282
  • Fax: 308-381-2150
Mailing address:
  • Phone: 308-382-4282
  • Fax: 308-381-2150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number066
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number241
License Number StateNE

VIII. Authorized Official

Name: BLAKE A STUDLEY
Title or Position: OWNER
Credential: AU.D.
Phone: 308-382-4282