Provider Demographics
NPI:1083345482
Name:COWBOY HEARING LLC
Entity Type:Organization
Organization Name:COWBOY HEARING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:SIMONS
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:307-460-2838
Mailing Address - Street 1:409 S 21ST ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-4323
Mailing Address - Country:US
Mailing Address - Phone:307-460-2838
Mailing Address - Fax:
Practice Address - Street 1:409 S 21ST ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-4323
Practice Address - Country:US
Practice Address - Phone:307-460-2838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty