Provider Demographics
NPI:1497181010
Name:ADVANCED HEARING SOLUTIONS, INC
Entity Type:Organization
Organization Name:ADVANCED HEARING SOLUTIONS, INC
Other - Org Name:MIRACLE-EAR HEARING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:LAYNE
Authorized Official - Last Name:HOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:307-337-5427
Mailing Address - Street 1:2657 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-2045
Mailing Address - Country:US
Mailing Address - Phone:307-266-0980
Mailing Address - Fax:
Practice Address - Street 1:2657 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-2045
Practice Address - Country:US
Practice Address - Phone:307-266-0980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY167332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment