Provider Demographics
NPI:1053445189
Name:AUDIOLOGY CENTER, INC.
Entity Type:Organization
Organization Name:AUDIOLOGY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:PIERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:307-432-9601
Mailing Address - Street 1:423 COLE SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-5370
Mailing Address - Country:US
Mailing Address - Phone:307-432-9601
Mailing Address - Fax:307-432-0411
Practice Address - Street 1:423 COLE SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5370
Practice Address - Country:US
Practice Address - Phone:307-432-9601
Practice Address - Fax:307-432-0411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYA-927332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY109738501Medicaid
WY308149Medicare PIN