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General NPI Number Information
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NPI Number | 1124432513
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Entity Type | Organization
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Legal Business Name | NEIDER HEARING LLC
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Dates
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Enumeration Date | 06/13/2014
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Last Update Date | 06/13/2014
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Provider Practice Location Address
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Address Line | 1543 POLE LINE RD E
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City | TWIN FALLS
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State | ID
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Zip | 83301-3590
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Country | US
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Telephone | 208-733-3340
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Fax |
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Provider Business Mailing Address
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Address Line | 162 FALLS AVENUE #303
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City | TWIN FALLS
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State | ID
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Zip | 83301
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Country | US
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Telephone | 801-682-6620
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. RYAN LEE NEIDER
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Credential | H.I.S.
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Telephone | 801-682-6620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | HA-2360
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License Number State | ID
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