Healthcare Provider Details

I. General information

NPI: 1164645354
Provider Name (Legal Business Name): PHILLIPS HEARING AID CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 CERRILLOS RD
SANTA FE NM
87507-4697
US

IV. Provider business mailing address

PO BOX 28417
SANTA FE NM
87592-8417
US

V. Phone/Fax

Practice location:
  • Phone: 505-474-3046
  • Fax: 505-474-3078
Mailing address:
  • Phone: 505-474-3046
  • Fax: 505-474-3078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number570
License Number StateNM

VIII. Authorized Official

Name: MRS. KAREN ELIZABETH PHILLIPS
Title or Position: VICE PRESIDENT
Credential: BA
Phone: 505-474-3046