Healthcare Provider Details

I. General information

NPI: 1346677622
Provider Name (Legal Business Name): PREMIER HEARING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 505-933-6315
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number0829
License Number StateNM

VIII. Authorized Official

Name: NAINA BALLACHANDA
Title or Position: CFO
Credential:
Phone: 505-821-6715