Healthcare Provider Details

I. General information

NPI: 1720447519
Provider Name (Legal Business Name): MODERN HEARING SOLUTIONS OF WYOMING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2016
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 PATRIOT DR
CODY WY
82414-8123
US

IV. Provider business mailing address

443 W COULTER AVE UNIT 6
POWELL WY
82435-2643
US

V. Phone/Fax

Practice location:
  • Phone: 307-254-9633
  • Fax: 307-460-7356
Mailing address:
  • Phone: 307-254-9633
  • Fax: 307-460-7356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number192
License Number StateWY

VIII. Authorized Official

Name: MR. DON DOUCET
Title or Position: MEMBER
Credential: HIS
Phone: 307-254-9633