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General NPI Number Information
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NPI Number | 1588953640
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Entity Type | Organization
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Legal Business Name | AUDIOLOGY AND HEARING CENTER OF GRAND ISLAND PC
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Dates
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Enumeration Date | 03/29/2011
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Last Update Date | 06/20/2011
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Provider Practice Location Address
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Address Line | 527 N DIERS AVE SUITE 4
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City | GRAND ISLAND
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State | NE
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Zip | 68803-4977
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Country | US
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Telephone | 308-382-4282
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Fax | 308-381-2150
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Provider Business Mailing Address
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Address Line | 527 N DIERS AVE SUITE 4
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City | GRAND ISLAND
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State | NE
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Zip | 68803-4977
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Country | US
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Telephone | 308-382-4282
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Fax | 308-381-2150
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Authorized Official
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Title or Position | OWNER
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Name | BLAKE A STUDLEY
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Credential | AU.D.
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Telephone | 308-382-4282
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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 | 066
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 241
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License Number State | NE
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