Provider Demographics
NPI:1124548607
Name:ADVANCED AUDIOLOGY OF GREATER OMAHA, LLC
Entity Type:Organization
Organization Name:ADVANCED AUDIOLOGY OF GREATER OMAHA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:402-758-5327
Mailing Address - Street 1:17021 LAKESIDE HILLS PLZ STE 202
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2390
Mailing Address - Country:US
Mailing Address - Phone:402-758-5327
Mailing Address - Fax:402-758-5328
Practice Address - Street 1:17021 LAKESIDE HILLS PLZ STE 202
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2390
Practice Address - Country:US
Practice Address - Phone:402-758-5327
Practice Address - Fax:402-758-5328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE348231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty