MEDICARE: HEARING HEALTH CARE CENTER

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	231H00000X	Audiologist	525	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	201079564	OTHER	PRESBYTERIAL HEALTH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	NM 00E119	OTHER	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1235116070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARING HEALTH CARE CENTER

Provider Business Mailing Address
First Line	:	5203 JUAN TABO BLVD NE STE 1F
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-2683
Country	:	US
Telephone Number	:	505-323-7373
Fax Number	:	505-323-2668

Provider Business Practice Location Address
First Line	:	5203 JUAN TABO BLVD NE STE 1F
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-2683
Country	:	US
Telephone Number	:	505-323-7373
Fax Number	:	505-323-2668

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN A LIONBARGER
Credential	:	AUD
Telephone Number	:	505-323-7373

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	11/01/2010

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Directions to “HEARING HEALTH CARE CENTER ” Practice Location

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