Healthcare Provider Details

I. General information

NPI: 1053445189
Provider Name (Legal Business Name): AUDIOLOGY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 COLE SHOPPING CTR
CHEYENNE WY
82001-5370
US

IV. Provider business mailing address

423 COLE SHOPPING CTR
CHEYENNE WY
82001-5370
US

V. Phone/Fax

Practice location:
  • Phone: 307-432-9601
  • Fax: 307-432-0411
Mailing address:
  • Phone: 307-432-9601
  • Fax: 307-432-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberA-927
License Number StateWY

VIII. Authorized Official

Name: MS. JAN S. PIERSON
Title or Position: AUDIOLOGIST
Credential: MS
Phone: 307-432-9601