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General NPI Number Information
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NPI Number | 1689038614
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Entity Type | Organization
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Legal Business Name | HEART RIVER HEARING AID PRACTICE
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Dates
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Enumeration Date | 04/06/2016
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Last Update Date | 04/06/2016
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Provider Practice Location Address
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Address Line | 1051 3RD AVE W
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City | DICKINSON
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State | ND
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Zip | 58601-3802
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Country | US
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Telephone | 701-227-0728
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Fax | 701-225-9554
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Provider Business Mailing Address
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Address Line | 1051 3RD AVE W
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City | DICKINSON
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State | ND
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Zip | 58601-3802
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Country | US
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Telephone | 701-227-0728
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Fax | 701-225-9554
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Authorized Official
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Title or Position | AUDIOLOGIST
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Name | DR. KIM B CALLAHAN
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Credential | AU.D.
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Telephone | 701-227-0728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | 331
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License Number State | ND
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