Provider Demographics
NPI:1235116070
Name:HEARING HEALTH CARE CENTER
Entity Type:Organization
Organization Name:HEARING HEALTH CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LIONBARGER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:505-323-7373
Mailing Address - Street 1:5203 JUAN TABO BLVD NE STE 1F
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2683
Mailing Address - Country:US
Mailing Address - Phone:505-323-7373
Mailing Address - Fax:505-323-2668
Practice Address - Street 1:5203 JUAN TABO BLVD NE STE 1F
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2683
Practice Address - Country:US
Practice Address - Phone:505-323-7373
Practice Address - Fax:505-323-2668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM525231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
201079564OtherPRESBYTERIAL HEALTH
NMK2423Medicaid
NM 00E119OtherBLUE CROSS BLUE SHIELD
349519901Medicare ID - Type Unspecified