1639200918 NPI number — SANDIA HEARING AIDS

Table of content: (NPI 1639200918)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639200918 NPI number — SANDIA HEARING AIDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANDIA HEARING AIDS
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:
PAUL WEBER
Provider Other Organization Name Type Code:
3
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:
1639200918
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 E LOHMAN AVE
Provider Second Line Business Mailing Address:
STE. #134
Provider Business Mailing Address City Name:
LAS CRUCES
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88001-3167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-523-0267
Provider Business Mailing Address Fax Number:
505-523-6408

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 E LOHMAN AVE
Provider Second Line Business Practice Location Address:
STE. #134
Provider Business Practice Location Address City Name:
LAS CRUCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88001-3167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-523-0267
Provider Business Practice Location Address Fax Number:
505-523-6408
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROGERS
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
CELESTE
Authorized Official Title or Position:
OFFICE MQNAGER
Authorized Official Telephone Number:
505-523-0267

Provider Taxonomy Codes

  • Taxonomy code: 237700000X , with the licence number:  553 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NMTB0037 . This is a "BLUE CROSS AND BLUE SHIEL" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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