Provider Demographics
NPI:1578620092
Name:SANDIA MEDICAL INSTRUMENTS
Entity Type:Organization
Organization Name:SANDIA MEDICAL INSTRUMENTS
Other - Org Name:SANDIA HEARING AIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-257-6800
Mailing Address - Street 1:10570 SE WASHINGTON ST
Mailing Address - Street 2:STE 210
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2846
Mailing Address - Country:US
Mailing Address - Phone:503-257-6800
Mailing Address - Fax:866-448-6830
Practice Address - Street 1:3301 MENAUL BLVD NE
Practice Address - Street 2:SUITE 26
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:NORTHLAND HEARING CETNER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-03
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM330237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMT9008Medicaid
NM300521112Medicare PIN