MEDICARE: MR. RAYMOND E BAMBERG BC-HIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	290	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1912915307	OTHER	NM	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912915307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAYMOND E BAMBERG BC-HIS

Provider Business Mailing Address
First Line	:	920 N TELSHOR BLVD
Second Line	:	SUITE A
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8244
Country	:	US
Telephone Number	:	505-523-8816
Fax Number	:	505-522-0026

Provider Business Practice Location Address
First Line	:	920 N TELSHOR BLVD
Second Line	:	SUITE A
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8244
Country	:	US
Telephone Number	:	505-523-8816
Fax Number	:	505-522-0026

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	06/23/2008

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Directions to “ MR. RAYMOND E BAMBERG BC-HIS” Practice Location

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