Provider Demographics
NPI:1811053531
Name:ROCKY MOUNTAIN HEARING AID CO OF MT, INC
Entity type:Organization
Organization Name:ROCKY MOUNTAIN HEARING AID CO OF MT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:406-755-5077
Mailing Address - Street 1:240 1ST AVE W
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4444
Mailing Address - Country:US
Mailing Address - Phone:406-755-5077
Mailing Address - Fax:406-755-5995
Practice Address - Street 1:240 1ST AVE W
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4444
Practice Address - Country:US
Practice Address - Phone:406-755-5077
Practice Address - Fax:406-755-5995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT122237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT73898OtherBLUECROSSBLUESHIELD