=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891489498
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WYOMING HEARING AID CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2023
-----------------------------------------------------
Last Update Date | 06/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 E 4TH ST SUITE 14
-----------------------------------------------------
City | GILETTE
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-689-4298
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 599
-----------------------------------------------------
City | BAYARD
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 69334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-631-1636
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | ANNETTE FRERICHS
-----------------------------------------------------
Credential | HIS
-----------------------------------------------------
Telephone | 308-631-1636
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------