Provider Demographics
NPI:1083806921
Name:BASIN AUDIOLOGY INC.
Entity Type:Organization
Organization Name:BASIN AUDIOLOGY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:DU BREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-884-3725
Mailing Address - Street 1:2578 DAGGETT AVE
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-1127
Mailing Address - Country:US
Mailing Address - Phone:541-884-3725
Mailing Address - Fax:541-885-5466
Practice Address - Street 1:2578 DAGGETT AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1127
Practice Address - Country:US
Practice Address - Phone:541-884-3725
Practice Address - Fax:541-885-5466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20852231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR026509Medicaid
139422Medicare PIN