Healthcare Provider Details

I. General information

NPI: 1316029945
Provider Name (Legal Business Name): PRESBYTERIAN EAR INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 CEDAR STREET SE
ALBUQUERQUE NM
87106-3927
US

IV. Provider business mailing address

415 CEDAR STREET SE
ALBUQUERQUE NM
87106-3927
US

V. Phone/Fax

Practice location:
  • Phone: 505-224-7020
  • Fax: 505-224-7023
Mailing address:
  • Phone: 505-224-7020
  • Fax: 505-224-7023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: KIM JOHNSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 505-224-7020