Provider Demographics
NPI:1508035692
Name:AUDIOLOGY ASSOCIATES OF GREELEY, INC.
Entity Type:Organization
Organization Name:AUDIOLOGY ASSOCIATES OF GREELEY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:TRAYNOR
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:970-352-2881
Mailing Address - Street 1:2528 16TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-4955
Mailing Address - Country:US
Mailing Address - Phone:970-352-2881
Mailing Address - Fax:970-352-5323
Practice Address - Street 1:2528 16TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4955
Practice Address - Country:US
Practice Address - Phone:970-352-2881
Practice Address - Fax:970-352-5323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO25231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1C1343Medicare UPIN