Provider Demographics
NPI:1508541285
Name:CONIFER HEARING AND TINNITUS
Entity Type:Organization
Organization Name:CONIFER HEARING AND TINNITUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FALLON
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-284-6004
Mailing Address - Street 1:36305 N GANTZEL RD STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-7326
Mailing Address - Country:US
Mailing Address - Phone:480-284-6004
Mailing Address - Fax:480-420-3659
Practice Address - Street 1:10791 KITTY DR STE B
Practice Address - Street 2:
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-7748
Practice Address - Country:US
Practice Address - Phone:720-900-2266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty