Provider Demographics
NPI:1285810721
Name:CHEYENNE HEARING CLINIC INC.
Entity type:Organization
Organization Name:CHEYENNE HEARING CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARLAN
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:WALTER
Authorized Official - Suffix:
Authorized Official - Credentials:MS MASTER OF SCIENCE
Authorized Official - Phone:307-635-0435
Mailing Address - Street 1:1401 AIRPORT PARKWAY
Mailing Address - Street 2:#230
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-1693
Mailing Address - Country:US
Mailing Address - Phone:307-635-0435
Mailing Address - Fax:307-432-0531
Practice Address - Street 1:1401 AIRPORT PARKWAY
Practice Address - Street 2:#230
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-1693
Practice Address - Country:US
Practice Address - Phone:307-635-0435
Practice Address - Fax:307-432-0531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYA909231H00000X, 332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY103277100Medicaid
WY103277101Medicaid
WY103277100Medicaid