Healthcare Provider Details

I. General information

NPI: 1609427764
Provider Name (Legal Business Name): BIG HORN BASIN HEARING AND SPEECH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 BLEISTEIN AVE
CODY WY
82414-3806
US

IV. Provider business mailing address

1535 BLEISTEIN AVE
CODY WY
82414-3806
US

V. Phone/Fax

Practice location:
  • Phone: 307-527-6475
  • Fax: 307-527-6483
Mailing address:
  • Phone: 307-527-6475
  • Fax: 307-527-6483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LEVI ASAY
Title or Position: OWNER
Credential:
Phone: 307-527-6475