Healthcare Provider Details

I. General information

NPI: 1578620092
Provider Name (Legal Business Name): SANDIA MEDICAL INSTRUMENTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 10/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 MENAUL BLVD NE SUITE 26
ALBUQUERQUE NM
87107-1852
US

IV. Provider business mailing address

10570 SE WASHINGTON ST STE 210
PORTLAND OR
97216-2846
US

V. Phone/Fax

Practice location:
  • Phone: 505-889-9100
  • Fax: 505-888-0363
Mailing address:
  • Phone: 503-257-6800
  • Fax: 866-448-6830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number330
License Number StateNM

VIII. Authorized Official

Name: MR. JEFF LONGTAIN
Title or Position: PRESIDENT
Credential:
Phone: 503-257-6800