Provider Demographics
NPI:1063264653
Name:BACH AND BOONE LLC
Entity type:Organization
Organization Name:BACH AND BOONE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:DRAPER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:484-885-7814
Mailing Address - Street 1:2555 CONTINENTAL CT STE 3
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-6093
Mailing Address - Country:US
Mailing Address - Phone:920-468-7474
Mailing Address - Fax:
Practice Address - Street 1:2555 CONTINENTAL CT STE 3
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6093
Practice Address - Country:US
Practice Address - Phone:920-468-7474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No332S00000XSuppliersHearing Aid Equipment