Provider Demographics
NPI:1124432513
Name:NEIDER HEARING LLC
Entity type:Organization
Organization Name:NEIDER HEARING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:NEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:801-682-6620
Mailing Address - Street 1:162 FALLS AVENUE #303
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301
Mailing Address - Country:US
Mailing Address - Phone:801-682-6620
Mailing Address - Fax:
Practice Address - Street 1:1543 POLE LINE RD E
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3590
Practice Address - Country:US
Practice Address - Phone:208-733-3340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDHA-2360237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty