Provider Demographics
NPI:1437269784
Name:SANDIA HEARING AIDS
Entity Type:Organization
Organization Name:SANDIA HEARING AIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-889-9100
Mailing Address - Street 1:3301 MENAUL BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-1852
Mailing Address - Country:US
Mailing Address - Phone:505-889-9100
Mailing Address - Fax:505-888-0363
Practice Address - Street 1:3301 MENAUL BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1852
Practice Address - Country:US
Practice Address - Phone:505-889-9100
Practice Address - Fax:505-888-0363
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANDIA MEDICAL INSTRUMENTS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-30
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM330231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMT9008Medicaid
NMT9008Medicaid
NM300521112Medicare ID - Type UnspecifiedGROUP/CLINIC PROVIDER NUM