Basic Information
Provider Information
NPI: 1528487741
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ARGO
FirstName: TRISTAN
MiddleName: R
NamePrefix:  
NameSuffix:  
Credential: HAF
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 110 RILEY ST
Address2:  
City: GADSDEN
State: AL
PostalCode: 359015432
CountryCode: US
TelephoneNumber: 2565472373
FaxNumber: 2565475353
Practice Location
Address1: 110 RILEY ST
Address2:  
City: GADSDEN
State: AL
PostalCode: 359015432
CountryCode: US
TelephoneNumber: 2565472373
FaxNumber: 2565475353
Other Information
ProviderEnumerationDate: 04/15/2014
LastUpdateDate: 04/16/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
237700000X2263ALY Speech, Language and Hearing Service ProvidersHearing Instrument Specialist 

No ID Information.


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