Healthcare Provider Details

I. General information

NPI: 1235116070
Provider Name (Legal Business Name): HEARING HEALTH CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 11/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5203 JUAN TABO BLVD NE STE 1F
ALBUQUERQUE NM
87111-2683
US

IV. Provider business mailing address

5203 JUAN TABO BLVD NE STE 1F
ALBUQUERQUE NM
87111-2683
US

V. Phone/Fax

Practice location:
  • Phone: 505-323-7373
  • Fax: 505-323-2668
Mailing address:
  • Phone: 505-323-7373
  • Fax: 505-323-2668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number525
License Number StateNM

VIII. Authorized Official

Name: JOHN A LIONBARGER
Title or Position: OWNER
Credential: AUD
Phone: 505-323-7373