Provider Demographics
NPI:1164854097
Name:ELDORADO AUDIOLOGY AND HEARING CENTER
Entity Type:Organization
Organization Name:ELDORADO AUDIOLOGY AND HEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:505-466-7526
Mailing Address - Street 1:5 CALIENTE ROAD
Mailing Address - Street 2:#5A
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508
Mailing Address - Country:US
Mailing Address - Phone:505-466-7526
Mailing Address - Fax:505-466-7528
Practice Address - Street 1:5 CALIENTE ROAD
Practice Address - Street 2:#5A
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508
Practice Address - Country:US
Practice Address - Phone:505-466-7526
Practice Address - Fax:505-466-7528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3966237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM34M716604Medicare PIN