Provider Demographics
NPI:1215053244
Name:DEGRYSE HEARING AID CENTER, INC.
Entity type:Organization
Organization Name:DEGRYSE HEARING AID CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGRYSE
Authorized Official - Suffix:
Authorized Official - Credentials:HAD
Authorized Official - Phone:605-737-9685
Mailing Address - Street 1:11879 BEVERLY JEAN RD
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:SD
Mailing Address - Zip Code:57785-6963
Mailing Address - Country:US
Mailing Address - Phone:605-737-9685
Mailing Address - Fax:605-737-7668
Practice Address - Street 1:1141 DEADWOOD AVE
Practice Address - Street 2:SUITE #10
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-0391
Practice Address - Country:US
Practice Address - Phone:605-737-9685
Practice Address - Fax:605-737-7668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD303H237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4996777OtherNON PPO# BCBS