Healthcare Provider Details

I. General information

NPI: 1598970253
Provider Name (Legal Business Name): PREMIER HEARING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 WYOMING BLVD NE SUITE A
ALBUQUERQUE NM
87109-6021
US

IV. Provider business mailing address

7920 WYOMING BLVD NE SUITE A
ALBUQUERQUE NM
87109-6021
US

V. Phone/Fax

Practice location:
  • Phone: 505-299-4327
  • Fax: 505-299-4327
Mailing address:
  • Phone: 505-821-6715
  • Fax: 505-821-0839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number2084
License Number StateNM

VIII. Authorized Official

Name: MR. SHAKIL DAVIS
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 505-821-6715