Provider Demographics
NPI:1508052705
Name:HIGH COUNTRY AUDIOLOGY, P.C.
Entity Type:Organization
Organization Name:HIGH COUNTRY AUDIOLOGY, P.C.
Other - Org Name:HIGH COUNTRY HEARING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:ALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:307-332-5088
Mailing Address - Street 1:125 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3149
Mailing Address - Country:US
Mailing Address - Phone:307-332-5088
Mailing Address - Fax:307-332-2378
Practice Address - Street 1:125 MAIN ST
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3149
Practice Address - Country:US
Practice Address - Phone:307-332-5088
Practice Address - Fax:307-332-2378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYA-901231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYA-901OtherSTATE OF WYOMING AUDIOLOG
WYW9094Medicare PIN