Provider Demographics
NPI:1427301019
Name:GARY WYATT ANDRUS
Entity type:Organization
Organization Name:GARY WYATT ANDRUS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:WYATT
Authorized Official - Last Name:ANDRUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-468-0400
Mailing Address - Street 1:1165 S DORA ST
Mailing Address - Street 2:STE B2
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-8325
Mailing Address - Country:US
Mailing Address - Phone:707-468-0400
Mailing Address - Fax:707-468-8240
Practice Address - Street 1:1165 S DORA ST
Practice Address - Street 2:STE B2
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-8325
Practice Address - Country:US
Practice Address - Phone:707-468-0400
Practice Address - Fax:707-468-8240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty