1316107600 NPI number — ZUNI AUDIOLOGY PROGRAM

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316107600 NPI number — ZUNI AUDIOLOGY PROGRAM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ZUNI AUDIOLOGY PROGRAM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316107600
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 339
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ZUNI
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87327-0339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-782-7233
Provider Business Mailing Address Fax Number:
505-782-7241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1203B STATE HWY 53
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ZUNI
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-782-7233
Provider Business Practice Location Address Fax Number:
505-782-7241
Provider Enumeration Date:
06/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HANNAWEEKA
Authorized Official First Name:
AVA
Authorized Official Middle Name:
Authorized Official Title or Position:
TRIBAL ADMINISTRATOR
Authorized Official Telephone Number:
505-782-7000

Provider Taxonomy Codes

  • Taxonomy code: 332S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 96083867 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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