Healthcare Provider Details

I. General information

NPI: 1629533641
Provider Name (Legal Business Name): ZIA HEARING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 02/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 N BUTLER AVE STE 5101
FARMINGTON NM
87401-2392
US

IV. Provider business mailing address

4001 N BUTLER AVE STE 5101
FARMINGTON NM
87401-2392
US

V. Phone/Fax

Practice location:
  • Phone: 505-326-2791
  • Fax: 505-564-2811
Mailing address:
  • Phone: 505-326-2791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTY LYNN TUCKER
Title or Position: HEARING AID DISPENSER/ OWNER
Credential: BC-HIS
Phone: 505-326-2791