Provider Demographics
NPI:1881978997
Name:CUSTOM HEARING SOLUTIONS
Entity type:Organization
Organization Name:CUSTOM HEARING SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ORESKOVICH
Authorized Official - Suffix:JR
Authorized Official - Credentials:HIS
Authorized Official - Phone:402-515-9228
Mailing Address - Street 1:8712 WYOMING ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-5245
Mailing Address - Country:US
Mailing Address - Phone:402-515-9228
Mailing Address - Fax:866-826-9730
Practice Address - Street 1:8712 WYOMING ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-5245
Practice Address - Country:US
Practice Address - Phone:402-515-9228
Practice Address - Fax:866-826-9730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE900773237700000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026089200Medicaid