Provider Demographics
NPI:1689038614
Name:HEART RIVER HEARING AID PRACTICE
Entity Type:Organization
Organization Name:HEART RIVER HEARING AID PRACTICE
Other - Org Name:HEART RIVER HEARING
Other - Org Type:Other Name
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:B
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:701-227-0728
Mailing Address - Street 1:1051 3RD AVE W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-3802
Mailing Address - Country:US
Mailing Address - Phone:701-227-0728
Mailing Address - Fax:701-225-9554
Practice Address - Street 1:1051 3RD AVE W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-3802
Practice Address - Country:US
Practice Address - Phone:701-227-0728
Practice Address - Fax:701-225-9554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND331261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1456322Medicaid
NDN722264Medicare UPIN