=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841744893
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEARING AID INSTITUTE OF KALISPELL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2016
-----------------------------------------------------
Last Update Date | 08/08/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1305 1ST AVE E
-----------------------------------------------------
City | KALISPELL
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59901-5801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-755-1945
-----------------------------------------------------
Fax | 406-341-4528
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1305 1ST AVE E
-----------------------------------------------------
City | KALISPELL
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59901-5801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-755-1945
-----------------------------------------------------
Fax | 406-314-4528
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MIKE R VAN DE RIET
-----------------------------------------------------
Credential | HAD
-----------------------------------------------------
Telephone | 406-755-1945
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332S00000X
-----------------------------------------------------
Taxonomy Name | Hearing Aid Equipment
-----------------------------------------------------
License Number | 235
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------