Basic Information
| Provider Information | |||||||||
| NPI: | 1194938837 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AUDIOLOGICAL CONSULTANTS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 230 S NEVADA AVE | ||||||||
| Address2: | |||||||||
| City: | MONTROSE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814014234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702520444 | ||||||||
| FaxNumber: | 9702527377 | ||||||||
| Practice Location | |||||||||
| Address1: | 230 S NEVADA AVE | ||||||||
| Address2: | |||||||||
| City: | MONTROSE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814014234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702520444 | ||||||||
| FaxNumber: | 9702527377 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | NORTHEY | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | JAMES | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3037617600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.S.M. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 101 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 04455093 | 05 | CO | MEDICAID |