Provider Demographics
NPI:1083803761
Name:WIND RIVER HEARING SERVICES
Entity Type:Organization
Organization Name:WIND RIVER HEARING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CELESTA
Authorized Official - Middle Name:CARTRITE
Authorized Official - Last Name:KOMRS
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC/A
Authorized Official - Phone:307-332-0284
Mailing Address - Street 1:269 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3121
Mailing Address - Country:US
Mailing Address - Phone:307-332-0284
Mailing Address - Fax:307-332-6334
Practice Address - Street 1:269 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3121
Practice Address - Country:US
Practice Address - Phone:307-332-0284
Practice Address - Fax:307-332-6334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYA964332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY311403OtherBCBS
WY9870Medicare PIN