Provider Demographics
NPI:1497343107
Name:HEALTH SERVICES WYOMING LLC
Entity Type:Organization
Organization Name:HEALTH SERVICES WYOMING LLC
Other - Org Name:MIRACLE EAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE AND BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLSOPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-310-7127
Mailing Address - Street 1:10557 W CARLTON BAY DR STE 201
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83714-5111
Mailing Address - Country:US
Mailing Address - Phone:208-310-7127
Mailing Address - Fax:208-912-0448
Practice Address - Street 1:10557 W CARLTON BAY DR STE 201
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:ID
Practice Address - Zip Code:83714-5111
Practice Address - Country:US
Practice Address - Phone:208-310-7127
Practice Address - Fax:208-912-0448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty