Provider Demographics
NPI:1457815524
Name:MODERN AUDIOLOGY CENTENNIAL LLC
Entity Type:Organization
Organization Name:MODERN AUDIOLOGY CENTENNIAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF AUDIOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:DEWITT
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:720-476-7132
Mailing Address - Street 1:9137 E MINERAL CIR STE 260
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3423
Mailing Address - Country:US
Mailing Address - Phone:720-476-7132
Mailing Address - Fax:720-476-7167
Practice Address - Street 1:9137 E MINERAL CIR STE 260
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3423
Practice Address - Country:US
Practice Address - Phone:720-476-7132
Practice Address - Fax:720-476-7167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies