Healthcare Provider Details

I. General information

NPI: 1245840966
Provider Name (Legal Business Name): ACTIVE HEARING HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18010 R PLZ STE 107
OMAHA NE
68135-1923
US

IV. Provider business mailing address

18010 R PLZ STE 107
OMAHA NE
68135-1923
US

V. Phone/Fax

Practice location:
  • Phone: 402-318-7863
  • Fax: 402-318-7885
Mailing address:
  • Phone: 402-318-7863
  • Fax: 402-318-7885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: NICOLE R KOPETZKY
Title or Position: OWNER
Credential: AU.D.
Phone: 402-318-7863