Provider Demographics
NPI:1164645354
Name:PHILLIPS HEARING AID CENTER, INC.
Entity Type:Organization
Organization Name:PHILLIPS HEARING AID CENTER, INC.
Other - Org Name:SANDIA HEARING AIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:505-474-3046
Mailing Address - Street 1:PO BOX 28417
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87592-8417
Mailing Address - Country:US
Mailing Address - Phone:505-474-3046
Mailing Address - Fax:505-474-3078
Practice Address - Street 1:4250 CERRILLOS RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4697
Practice Address - Country:US
Practice Address - Phone:505-474-3046
Practice Address - Fax:505-474-3078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM570174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty