Provider Demographics
NPI:1780879676
Name:MARK KRIPAL HEARING & AUDIOLOGY LLC
Entity type:Organization
Organization Name:MARK KRIPAL HEARING & AUDIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:JAYNE
Authorized Official - Last Name:KRIPAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-532-3334
Mailing Address - Street 1:PO BOX 795
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69103-0795
Mailing Address - Country:US
Mailing Address - Phone:308-532-3330
Mailing Address - Fax:308-532-3334
Practice Address - Street 1:801 WILLIAM AVE
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6556
Practice Address - Country:US
Practice Address - Phone:308-532-3330
Practice Address - Fax:308-532-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE639237700000X
NE166231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100251338-00Medicaid
NE100251241-00Medicaid
36804OtherBLUE CROSS
NE100251241-00Medicaid