Healthcare Provider Details

I. General information

NPI: 1992073381
Provider Name (Legal Business Name): HEARMART HEARING AIDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 SAN PEDRO DR NE STE 5
ALBUQUERQUE NM
87110-5956
US

IV. Provider business mailing address

1820 SAN PEDRO DR NE STE 5
ALBUQUERQUE NM
87110-5956
US

V. Phone/Fax

Practice location:
  • Phone: 505-255-8000
  • Fax: 505-256-4751
Mailing address:
  • Phone: 505-255-8000
  • Fax: 505-256-4751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number02-414902-00-0
License Number StateNM

VIII. Authorized Official

Name: MR. GEORGE S BOURNE JR.
Title or Position: OWNER
Credential: BCHIS
Phone: 505-255-8000