Provider Demographics
NPI:1720447519
Name:MODERN HEARING SOLUTIONS OF WYOMING, LLC
Entity Type:Organization
Organization Name:MODERN HEARING SOLUTIONS OF WYOMING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUCET
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:307-254-9633
Mailing Address - Street 1:443 W COULTER AVE
Mailing Address - Street 2:UNIT 6
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-2643
Mailing Address - Country:US
Mailing Address - Phone:307-254-9633
Mailing Address - Fax:307-460-7356
Practice Address - Street 1:17 PATRIOT DR
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-8123
Practice Address - Country:US
Practice Address - Phone:307-254-9633
Practice Address - Fax:307-460-7356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY192332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment