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General NPI Number Information
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NPI Number | 1063883833
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Entity Type | Organization
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Legal Business Name | ARKANSAS VALLEY HEARING INC
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Dates
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Enumeration Date | 10/19/2015
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Last Update Date | 10/19/2015
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Provider Practice Location Address
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Address Line | 509 COLORADO AVE STE A
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City | PUEBLO
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State | CO
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Zip | 81004-2008
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Country | US
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Telephone | 719-582-1614
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Fax |
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Provider Business Mailing Address
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Address Line | 509 COLORADO AVE SUITE A
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City | PUEBLO
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State | CO
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Zip | 81004
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Country | US
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Telephone | 719-582-1614
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Fax |
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Authorized Official
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Title or Position | OWNER/HEARING AID SPECIALIST
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Name | GARY LEE DAUGHTREY
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Credential | HIS APPRENTICE #32
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Telephone | 719-582-1614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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License Number | 32
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License Number State | CO
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