Provider Demographics
NPI:1528469566
Name:HEARING AID INSTITUTE OF MISSOULA
Entity type:Organization
Organization Name:HEARING AID INSTITUTE OF MISSOULA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN DE RIET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-543-5025
Mailing Address - Street 1:705 S. RESERVE ST. #B
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801
Mailing Address - Country:US
Mailing Address - Phone:406-543-5025
Mailing Address - Fax:406-721-6071
Practice Address - Street 1:705 S. RESERVE ST.
Practice Address - Street 2:#B
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801
Practice Address - Country:US
Practice Address - Phone:406-543-5025
Practice Address - Fax:406-721-6071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235333600000X, 237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
No333600000XSuppliersPharmacyGroup - Multi-Specialty