Healthcare Provider Details

I. General information

NPI: 1528682945
Provider Name (Legal Business Name): NEW MEXICO HEARING AID & TINNITUS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 01/03/2022
Certification Date: 01/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5553 LILAC PL NE
RIO RANCHO NM
87144-5804
US

IV. Provider business mailing address

5553 LILAC PL NE
RIO RANCHO NM
87144-5804
US

V. Phone/Fax

Practice location:
  • Phone: 505-235-0110
  • Fax: 505-771-2353
Mailing address:
  • Phone: 505-235-0110
  • Fax: 505-771-2353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL MACDONALD
Title or Position: OWNER, MANAGING PARTNER
Credential:
Phone: 505-235-0110