Healthcare Provider Details

I. General information

NPI: 1881223311
Provider Name (Legal Business Name): AZTEC ENITITES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8617 W POINT DOUGLAS RD S STE 150
COTTAGE GROVE MN
55016-4161
US

IV. Provider business mailing address

8151 RIVER ACRES RD
COTTAGE GROVE MN
55016-4566
US

V. Phone/Fax

Practice location:
  • Phone: 833-432-7483
  • Fax: 651-205-3501
Mailing address:
  • Phone: 833-432-7483
  • Fax: 651-205-3501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: SUE CHAMBERLAIN
Title or Position: HEARING AID DISPENSER, OWNER
Credential: NBC-HIS
Phone: 833-432-7483