Provider Demographics
NPI:1710448527
Name:BROADMOOR HEARING CLINIC LLC
Entity Type:Organization
Organization Name:BROADMOOR HEARING CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:303-322-0054
Mailing Address - Street 1:90 MADISON ST STE 201
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5411
Mailing Address - Country:US
Mailing Address - Phone:303-322-0054
Mailing Address - Fax:303-355-5879
Practice Address - Street 1:1685 BRIARGATE BLVD STE D
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3417
Practice Address - Country:US
Practice Address - Phone:719-388-1404
Practice Address - Fax:303-355-5879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty