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General NPI Number Information
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NPI Number | 1457911695
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Entity Type | Organization
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Legal Business Name | MODERN AUDIOLOGY MINNESOTA, INC.
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Dates
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Enumeration Date | 06/19/2019
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Last Update Date | 09/08/2021
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Provider Practice Location Address
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Address Line | 6600 LYNDALE AVE S STE 140
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City | RICHFIELD
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State | MN
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Zip | 55423-3398
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Country | US
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Telephone | 612-888-3719
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Fax | 612-354-2665
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Provider Business Mailing Address
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Address Line | 6600 LYNDALE AVE S STE 140
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City | RICHFIELD
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State | MN
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Zip | 55423-3398
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Country | US
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Telephone | 612-888-3719
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Fax | 612-354-2665
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Authorized Official
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Title or Position | OWNER
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Name | MR. DALE WOODARD
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Credential | BC-HIS
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Telephone | 612-888-3791
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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 |
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License Number State |
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