Provider Demographics
NPI:1457911695
Name:MODERN AUDIOLOGY MINNESOTA, INC.
Entity Type:Organization
Organization Name:MODERN AUDIOLOGY MINNESOTA, INC.
Other - Org Name:MODERN AUDIOLOGY MINNESOTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODARD
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:612-888-3791
Mailing Address - Street 1:6600 LYNDALE AVE S STE 140
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-3398
Mailing Address - Country:US
Mailing Address - Phone:612-888-3719
Mailing Address - Fax:612-354-2665
Practice Address - Street 1:6600 LYNDALE AVE S STE 140
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-3398
Practice Address - Country:US
Practice Address - Phone:612-888-3719
Practice Address - Fax:612-354-2665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-19
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment