Provider Demographics
NPI:1598970253
Name:PREMIER HEARING CENTER LLC
Entity Type:Organization
Organization Name:PREMIER HEARING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAKIL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-821-6715
Mailing Address - Street 1:7920 WYOMING BLVD NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6021
Mailing Address - Country:US
Mailing Address - Phone:505-821-6715
Mailing Address - Fax:505-821-0839
Practice Address - Street 1:7920 WYOMING BLVD NE
Practice Address - Street 2:SUITE A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-6021
Practice Address - Country:US
Practice Address - Phone:505-299-4327
Practice Address - Fax:505-299-4327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2084237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty