Provider Demographics
NPI:1407937279
Name:RUDDEN AUDIOLOGY, INC.
Entity Type:Organization
Organization Name:RUDDEN AUDIOLOGY, INC.
Other - Org Name:LONGMONT HEARING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:D'ANNE
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:RUDDEN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD CCC-A
Authorized Official - Phone:303-651-1178
Mailing Address - Street 1:195 S MAIN ST STE 8
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6218
Mailing Address - Country:US
Mailing Address - Phone:303-651-1178
Mailing Address - Fax:303-651-0488
Practice Address - Street 1:195 S MAIN ST STE 8
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6218
Practice Address - Country:US
Practice Address - Phone:303-651-1178
Practice Address - Fax:303-651-0488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO172231H00000X, 237600000X
COCO429231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC460268Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
CODB9065Medicare ID - Type UnspecifiedRAILROAD MEDICARE