PUEBLO AUDIOLOGY CENTER (NPI# 1487862835) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487862835 |
| Entity Type | Organization |
| Organization Name | PUEBLO AUDIOLOGY CENTER |
| Practice Address |
712 Fortino Blvd Suite D Pueblo CO 81008-2084 |
| Practice Telephone | 7195421760 |
| Practice Fax Number | 7195425115 |
| Mailing Telephone | 7195421760 |
| Mailing Fax Number | 7195425115 |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2008-04-01 |
| Authorized Official Name | TY SQUIRES (AUDIOLOGIST) |
| Authorized Official Telephone | 7195421760 |
| Authorized Official Credential | MS, CCC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 231H00000X | Audiologist | Speech, Language and Hearing Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CO | 14421739 | 05 | |
| RR MEDICARE | DC9518 | 01 | |
| RR MEDICARE PIN | P00200291 | 01 | |
| BCBS | PU668438 | 01 |
| Street Address |
712 FORTINO BLVD SUITE D |
| City | PUEBLO |
| State | CO |
| Zip Code | 81008-2084 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487673356 | Steven Ray Clough | Optometrist | 712 Fortino Blvd, Pueblo, CO 81008-2084 | 2006-07-19 |
| 1912116195 | Family Eye Center Incorporated | Optometrist | 712 Fortino Blvd, Pueblo, CO 81008-2084 | 2007-05-22 |
| 1871618108 | Karen Malott Gacnik | Audiologist | 712 Fortino Blvd, Ste. D, Pueblo, CO 81008-2084 | 2007-03-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164058913 | Healthone Clinic Services - Oncology Hematology LLC | Internal Medicine | 3678 Parker Blvd, Pueblo, CO 81008 | 2020-03-12 |
| 1073026423 | Carmel Community Living Corporation | Respite Care | 2003 Northmoor Terrace, Suite 100, Pueblo, CO 81008 | 2017-11-08 |
| 1568987121 | Hannah Vivian Roadruck | Pharmacist | 4200 Dillon Dr., Pueblo, CO 81008 | 2017-08-04 |
| 1184170425 | Brett Burana | Dentist | 729 Us-50, Pueblo, CO 81008 | 2016-08-28 |
| 1760832885 | Irby Dental Cottage | Dental Hygienist | 2099 West St # 50, Suite 180, Pueblo, CO 81008 | 2016-06-20 |
| 1649624362 | Curley Peak Dentistry Pllc | Dentist | 1640 W Fortino Blvd, Pueblo, CO 81008 | 2016-04-19 |
| 1336507847 | Kyle Tipton | Nurse Anesthetist, Certified Registered | 4741 Eagleridge Circle, 206, Pueblo, CO 81008 | 2016-01-29 |
| 1407211931 | Center At Park West, LLC | Skilled Nursing Facility | 3727 Parker Blvd., Pueblo, CO 81008 | 2015-12-29 |
| 1417327461 | Nicole Betts | Registered Nurse | 1310 Fortino Blvd Ste D, Pueblo, CO 81008 | 2015-10-02 |
| 1437578028 | Pueblo Modern Dentistry and Orthodontics, LLP | Dentist | 727 Us Hwy 50 West, Pueblo, CO 81008 | 2014-04-10 |
| Find all providers in zip 81008 | ||||
| Taxonomy Code | 231H00000X |
| Grouping | Speech, Language and Hearing Service Providers |
| Classification | Audiologist |
| (1) A specialist in evaluation, habilitation and rehabilitation of those whose communication disorders center in whole or in part in hearing function. Audiologists are autonomous professionals who identify, assess, and manage disorders of the auditory, balance and other neural systems. Audiologists provide audiological (aural) rehabilitation to children and adults across the entire age span. Audiologists select, fit and dispense amplification systems such as hearing aids and related devices. (2) An audiologist is a person qualified by a master’s degree in audiology, licensed by the state, where applicable, and practicing within the scope of that license. Audiologists evaluate and treat patients with impaired hearing. They plan, direct and conduct rehabilitative programs with audiotry substitutional devises (hearing aids) and other therapy. |
| Notes: Source: (1) American Speech-Language-Hearing Association, (1996, Spring) Scope of practice in Audiology, p. 2 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063614394 | Theodora J. Bronken | Audiologist | 215 E Orman Ave, Pueblo, CO 81004-2143 | 2007-05-31 |
| 1497966154 | Mary Kay Witte | Audiologist | 1471 29th Ln, Pueblo, CO 81006-9649 | 2007-05-24 |
| 1164596060 | Huh Inc Dba Pueblo Hearing Aid Services | Audiologist | 1000 W 6th St Ste H, Pueblo, CO 81003-2389 | 2006-11-20 |
| 1275144578 | Rebecca Shannon Welles | Audiologist | 4776 Eagleridge Cir, Pueblo, CO 81008-2189 | 2020-08-11 |
| 1700448966 | Jessica Blaettler | Audiologist | 4776 Eagleridge Cir, Pueblo, CO 81008-2189 | 2019-07-08 |
| 1558887075 | Leticia Nunez | Audiologist | 4776 Eagleridge Cir, Pueblo, CO 81008-2189 | 2017-08-16 |
| 1609271014 | Kristine Hulet | Audiologist | 3201 Dillon Dr, Pueblo, CO 81008-1005 | 2014-10-28 |
| 1912178880 | Nichole Renee Kovel | Audiologist | 1218 S Pueblo Blvd, Pueblo, CO 81005-1593 | 2008-03-18 |
| 1134259286 | Ruth M. Miller | Audiologist | 1218 S Pueblo Blvd, Pueblo, CO 81005-1593 | 2007-03-07 |
| 1760559561 | Andrae C Lucas | Audiologist | 1619 N Greenwood, Suite 309, Pueblo, CO 81003-2657 | 2006-11-29 |
| Find all providers in PUEBLO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.