Provider Demographics
NPI:1710356985
Name:ARKANSAS VALLEY HEARING INC
Entity Type:Organization
Organization Name:ARKANSAS VALLEY HEARING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/HEARING AID SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DAUGHTREY
Authorized Official - Suffix:
Authorized Official - Credentials:HIS APPRENTICE #32
Authorized Official - Phone:719-691-2446
Mailing Address - Street 1:206 S 4TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-2820
Mailing Address - Country:US
Mailing Address - Phone:719-691-2446
Mailing Address - Fax:
Practice Address - Street 1:206 S 4TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-2820
Practice Address - Country:US
Practice Address - Phone:719-691-2446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO332S00000X332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1154668275OtherNPI NUMBER FOR OTHER OFFICE IN LA JUNTA, COLORADO 81050