MEDICARE: SOUTHWEST HEARING ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	502	NM

General Provider Information

NPI Number	:	1124270020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST HEARING ASSOCIATES

Provider Business Mailing Address
First Line	:	2839 CARLISLE BLVD NE STE 110
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-2877
Country	:	US
Telephone Number	:	505-883-3212
Fax Number	:	505-881-1622

Provider Business Practice Location Address
First Line	:	2839 CARLISLE BLVD NE STE 110
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-2877
Country	:	US
Telephone Number	:	505-883-3212
Fax Number	:	505-881-1622

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHANE ANTHONY JARAMILLO
Credential	:	HIS
Telephone Number	:	505-883-3212

Provider Enumeration Date	:	10/22/2008
Last Update Date	:	10/22/2008

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