Provider Demographics
NPI:1477715910
Name:FIRE AUDIOLOGICAL SERVICES P.C.
Entity Type:Organization
Organization Name:FIRE AUDIOLOGICAL SERVICES P.C.
Other - Org Name:FIRE AUDIOLOGY & HEARING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROGALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-787-5862
Mailing Address - Street 1:121 NORTH WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203-3400
Mailing Address - Country:US
Mailing Address - Phone:701-787-5862
Mailing Address - Fax:701-738-2371
Practice Address - Street 1:121 NORTH WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58203-3400
Practice Address - Country:US
Practice Address - Phone:701-787-5862
Practice Address - Fax:701-738-2371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND441231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDFIR19598OtherBLUE CROSS BLUE SHIELD
ND51100Medicaid
MN1G724FIOtherBLUE CROSS BLUE SHIELD
MN1G724FIOtherBLUE CROSS BLUE SHIELD