Healthcare Provider Details

I. General information

NPI: 1144963133
Provider Name (Legal Business Name): HIGH DESERT HEARING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 24 1/2 RD STE G
GRAND JUNCTION CO
81505-1371
US

IV. Provider business mailing address

631 24 1/2 RD STE G
GRAND JUNCTION CO
81505-1371
US

V. Phone/Fax

Practice location:
  • Phone: 970-985-8765
  • Fax:
Mailing address:
  • Phone: 970-985-4008
  • Fax: 970-985-4037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: TERRY L JACOBSON
Title or Position: OFFICER/ADMINISTRATOR
Credential:
Phone: 970-985-4008