Provider Demographics
NPI:1801988084
Name:BIG HORN BASIN HEARING INC
Entity type:Organization
Organization Name:BIG HORN BASIN HEARING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KOPERSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCCA FAAA
Authorized Official - Phone:307-527-6475
Mailing Address - Street 1:721 SHERIDAN AVE
Mailing Address - Street 2:STE 150 BIG HORN BASIN HEARING INC
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414
Mailing Address - Country:US
Mailing Address - Phone:307-527-6475
Mailing Address - Fax:307-527-6483
Practice Address - Street 1:721 SHERIDAN AVE
Practice Address - Street 2:STE 150 BIG HORN BASIN HEARING INC
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414
Practice Address - Country:US
Practice Address - Phone:307-527-6475
Practice Address - Fax:307-527-6483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYAUDIOLOGY CLINIC231H00000X
WYAUDIOLOGY CLINIC HEA237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY9347Medicare ID - Type Unspecified