Healthcare Provider Details

I. General information

NPI: 1063264653
Provider Name (Legal Business Name): BACH AND BOONE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 CONTINENTAL CT STE 3
GREEN BAY WI
54311-6093
US

IV. Provider business mailing address

2555 CONTINENTAL CT STE 3
GREEN BAY WI
54311-6093
US

V. Phone/Fax

Practice location:
  • Phone: 920-468-7474
  • Fax:
Mailing address:
  • Phone: 920-468-7474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. EVAN F DRAPER
Title or Position: MANAGING MEMBER
Credential: AUD
Phone: 484-885-7814