Healthcare Provider Details

I. General information

NPI: 1003316639
Provider Name (Legal Business Name): TIMBERLINE HEARING, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 02/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 N BROADWAY AVE
RIVERTON WY
82501-3543
US

IV. Provider business mailing address

218 N BROADWAY AVE
RIVERTON WY
82501-3543
US

V. Phone/Fax

Practice location:
  • Phone: 307-856-3847
  • Fax: 307-856-7484
Mailing address:
  • Phone: 307-856-3847
  • Fax: 307-856-7484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number103
License Number StateWY

VIII. Authorized Official

Name: PATRICIA E. JOHNSON
Title or Position: OWNER/H.A. SPECIALIST/AUDIOLOGIST
Credential: M.A., CCC-A
Phone: 307-856-3847