Provider Demographics
NPI:1538135181
Name:SOUTHWEST HEARING SERVICES INC
Entity Type:Organization
Organization Name:SOUTHWEST HEARING SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCER BALDUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-249-2369
Mailing Address - Street 1:816 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5765
Mailing Address - Country:US
Mailing Address - Phone:970-249-2369
Mailing Address - Fax:970-249-0219
Practice Address - Street 1:816 S 5TH ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5765
Practice Address - Country:US
Practice Address - Phone:970-249-2369
Practice Address - Fax:970-249-0219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO89231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07001712Medicaid