Provider Demographics
NPI:1154913622
Name:BLACK HILLS ADVANCED HEARING LLC
Entity type:Organization
Organization Name:BLACK HILLS ADVANCED HEARING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OSTEOPATHY
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:W
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:605-716-6390
Mailing Address - Street 1:4940 5TH ST STE 2B
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-6026
Mailing Address - Country:US
Mailing Address - Phone:605-388-5781
Mailing Address - Fax:605-716-6390
Practice Address - Street 1:4940 5TH ST STE 2B
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-6026
Practice Address - Country:US
Practice Address - Phone:605-388-5781
Practice Address - Fax:605-716-6390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-06
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty