Provider Demographics
NPI:1205205648
Name:PUEBLO HEARING AIDS LLC
Entity Type:Organization
Organization Name:PUEBLO HEARING AIDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:STOCKTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-276-1082
Mailing Address - Street 1:1000 W 6TH ST
Mailing Address - Street 2:STE H
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2316
Mailing Address - Country:US
Mailing Address - Phone:719-543-2116
Mailing Address - Fax:719-543-2216
Practice Address - Street 1:1000 W 6TH ST
Practice Address - Street 2:STE H
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2316
Practice Address - Country:US
Practice Address - Phone:719-543-2116
Practice Address - Fax:719-543-2216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment