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NPI Code Detail

MEDICARE: WYOMING HEARING CLINIC, LLC

MEDICARE: WYOMING HEARING CLINIC, 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
1261QH0700XHearing and Speech Clinic/CenterA-954WY

General Provider Information

NPI Number : 1710156138
Entity Type Code : Organization
Provider Name (Legal Business Name) : WYOMING HEARING CLINIC, LLC
Provider Business Mailing Address
First Line : 5320 EDUCATION DR
Second Line :
City : CHEYENNE
State : WY
Zip : 82009-4058
Country : US
Telephone Number : 307-632-8224
Fax Number : 307-635-3691
Provider Business Practice Location Address
First Line : 5320 EDUCATION DR
Second Line :
City : CHEYENNE
State : WY
Zip : 82009-4058
Country : US
Telephone Number : 307-632-8224
Fax Number : 307-635-3691
Authorized Official
Title or Position : OWNER/AUDIOLOGIST
Name : MR. JONATHAN M ROSS
Credential : MS CCC-A
Telephone Number : 307-632-8224
Provider Enumeration Date : 02/29/2008
Last Update Date : 02/29/2008

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Directions to “WYOMING HEARING CLINIC, LLC ” Practice Location

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