Provider Demographics
NPI:1811010044
Name:STANFORDROLAND LTD
Entity Type:Organization
Organization Name:STANFORDROLAND LTD
Other - Org Name:STANFORD HEARING AIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:STANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCA
Authorized Official - Phone:605-338-6251
Mailing Address - Street 1:301 W 14TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-6841
Mailing Address - Country:US
Mailing Address - Phone:605-338-6251
Mailing Address - Fax:605-333-0018
Practice Address - Street 1:301 W 14TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-6841
Practice Address - Country:US
Practice Address - Phone:605-338-6251
Practice Address - Fax:605-333-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0077372OtherWELLMARK BLUE CROSS
SD9150560Medicaid
SD9150560Medicaid