MEDICARE: COWBOY HEARING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist

General Provider Information

NPI Number	:	1083345482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COWBOY HEARING LLC

Provider Business Mailing Address
First Line	:	409 S 21ST ST
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82070-4323
Country	:	US
Telephone Number	:	307-460-2838
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 S 21ST ST
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82070-4323
Country	:	US
Telephone Number	:	307-460-2838
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ROBERT R SIMONS
Credential	:	HIS
Telephone Number	:	307-460-2838

Provider Enumeration Date	:	06/17/2022
Last Update Date	:	06/17/2022

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