Provider Demographics
NPI:1205983962
Name:ANIMAS VALLEY AUDIOLOGY LLC
Entity type:Organization
Organization Name:ANIMAS VALLEY AUDIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOEBEL
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-A
Authorized Official - Phone:970-375-2369
Mailing Address - Street 1:799 E 3RD ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5793
Mailing Address - Country:US
Mailing Address - Phone:970-375-2369
Mailing Address - Fax:
Practice Address - Street 1:799 E 3RD ST
Practice Address - Street 2:SUITE 1
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5793
Practice Address - Country:US
Practice Address - Phone:970-375-2369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO47231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07361181Medicaid
COC808215Medicare PIN