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NPI Code Detail

MEDICARE: BLACK HILLS ADVANCED HEARING LLC

MEDICARE: BLACK HILLS ADVANCED 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
1231H00000XAudiologist
2237600000XAudiologist-Hearing Aid Fitter

General Provider Information

NPI Number : 1154913622
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLACK HILLS ADVANCED HEARING LLC
Provider Business Mailing Address
First Line : 4940 5TH ST STE 2B
Second Line :
City : RAPID CITY
State : SD
Zip : 57701-6026
Country : US
Telephone Number : 605-388-5781
Fax Number : 605-716-6390
Provider Business Practice Location Address
First Line : 4940 5TH ST STE 2B
Second Line :
City : RAPID CITY
State : SD
Zip : 57701-6026
Country : US
Telephone Number : 605-388-5781
Fax Number : 605-716-6390
Authorized Official
Title or Position : DOCTOR OF OSTEOPATHY
Name : JAY W WHITE
Credential : DO
Telephone Number : 605-716-6390
Provider Enumeration Date : 02/06/2021
Last Update Date : 02/08/2021

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