Pueblo Audiology Center

Primary specialty

AudiologistTaxonomy code 231H00000X

Legal business name

PUEBLO AUDIOLOGY CENTER

Practice address

712 Fortino Blvd
Suite D
Pueblo, CO 81008-2084

Phone

(719) 542-1760

Fax

(719) 542-5115

NPI assigned

May 18, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ty Squires, MS, CCC

Title

Audiologist

Phone

(719) 542-1760

Specialties & licenses 1

Addresses

Other identifiers 4

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Karen Malott Gacnik, M.S. CCC-A

  • Assistive Technology Practitioner Audiologist
  • Pueblo, CO
  • NPI 1871618108
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207008000000",
    "number": "1487862835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "712 FORTINO BLVD",
            "address_2": "SUITE D",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082084",
            "telephone_number": "719-542-1760",
            "fax_number": "719-542-5115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 FORTINO BLVD",
            "address_2": "SUITE D",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082084",
            "telephone_number": "719-542-1760",
            "fax_number": "719-542-5115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUEBLO AUDIOLOGY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2008-04-01",
        "status": "A",
        "authorized_official_last_name": "SQUIRES",
        "authorized_official_first_name": "TY",
        "authorized_official_title_or_position": "AUDIOLOGIST",
        "authorized_official_telephone_number": "719-542-1760",
        "authorized_official_credential": "MS, CCC"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Audiologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14421739",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "PU668438",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PIN",
            "identifier": "P00200291",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DC9518",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Audiologist in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Audiologist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.