Healthcare Provider Details

I. General information

NPI: 1013654003
Provider Name (Legal Business Name): ADVANCED HEARING SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 5TH ST STE 2B
RAPID CITY SD
57701-6026
US

IV. Provider business mailing address

4940 5TH ST STE 2B
RAPID CITY SD
57701-6026
US

V. Phone/Fax

Practice location:
  • Phone: 605-415-0038
  • Fax:
Mailing address:
  • Phone: 605-415-0038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number StateNULL

VIII. Authorized Official

Name: TAMMY VON COLLN
Title or Position: OFFICE MANAGER
Credential:
Phone: 605-415-0038