Provider Demographics
NPI:1205192440
Name:FUGLEBERG ENTERPRISES INC
Entity Type:Organization
Organization Name:FUGLEBERG ENTERPRISES INC
Other - Org Name:MISSOULA'S HEARING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:FUGLEBERG
Authorized Official - Last Name:HINTHER
Authorized Official - Suffix:
Authorized Official - Credentials:MCSD, CCC-A
Authorized Official - Phone:406-542-5200
Mailing Address - Street 1:2831 FORT MISSOULA RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7419
Mailing Address - Country:US
Mailing Address - Phone:406-542-5200
Mailing Address - Fax:406-542-1951
Practice Address - Street 1:2831 FORT MISSOULA RD
Practice Address - Street 2:SUITE 300
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7419
Practice Address - Country:US
Practice Address - Phone:406-542-5200
Practice Address - Fax:406-542-1951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT676231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000029328OtherBLUE CROSS BLUE SHIELD MONTANA
MT0532440Medicaid
MT0561391Medicaid