Provider Demographics
NPI:1881835304
Name:PLATTE VALLEY HEARING CENTER, INC.
Entity Type:Organization
Organization Name:PLATTE VALLEY HEARING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OR AUDIOLOGY, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:F
Authorized Official - Last Name:KEENAN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:970-867-9993
Mailing Address - Street 1:409 E PLATTE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701-3335
Mailing Address - Country:US
Mailing Address - Phone:970-867-9993
Mailing Address - Fax:970-867-0622
Practice Address - Street 1:409 E PLATTE AVE
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-3335
Practice Address - Country:US
Practice Address - Phone:970-867-9993
Practice Address - Fax:970-867-0622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-12
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO100237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO46122877Medicaid
CO46122877Medicaid
COC8853Medicare UPIN
C8853Medicare PIN