Provider Demographics
NPI:1477939718
Name:RIVER VALLEY AUDIOLOGY LLC
Entity Type:Organization
Organization Name:RIVER VALLEY AUDIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BEUTEL
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:7152-450-5205
Mailing Address - Street 1:215 N 2ND ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-3706
Mailing Address - Country:US
Mailing Address - Phone:715-245-0525
Mailing Address - Fax:
Practice Address - Street 1:215 N 2ND ST
Practice Address - Street 2:SUITE 101
Practice Address - City:RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54022-3706
Practice Address - Country:US
Practice Address - Phone:715-245-0525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI197-156332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment