Healthcare Provider Details

I. General information

NPI: 1699921882
Provider Name (Legal Business Name): TRIBAL AUDIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5015 PROSPECT AVE NE
ALBUQUERQUE NM
87110-4045
US

IV. Provider business mailing address

5015 PROSPECT AVE NE
ALBUQUERQUE NM
87110-4045
US

V. Phone/Fax

Practice location:
  • Phone: 505-764-0036
  • Fax: 505-764-0446
Mailing address:
  • Phone: 505-764-0036
  • Fax: 505-764-0446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: CHRIS ATKINSON
Title or Position: AUDIOLOGY PROGRAM MANAGER
Credential:
Phone: 505-764-0036