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General NPI Number Information
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NPI Number | 1053187294
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Entity Type | Organization
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Legal Business Name | SNAKE RIVER HEARING AND BALANCE LLC
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Dates
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Enumeration Date | 11/29/2023
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Last Update Date | 11/29/2023
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Provider Practice Location Address
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Address Line | 1582 ELK CREEK DR
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City | IDAHO FALLS
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State | ID
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Zip | 83404-8322
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Country | US
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Telephone | 208-542-5414
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Fax |
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Provider Business Mailing Address
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Address Line | 1582 ELK CREEK DR
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City | IDAHO FALLS
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State | ID
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Zip | 83404-8322
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Country | US
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Telephone | 208-542-5414
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CRAIG ALLRED
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Credential | AUD
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Telephone | 208-542-5414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number |
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License Number State |
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