Provider Demographics
NPI:1629533641
Name:ZIA HEARING CENTER, LLC
Entity Type:Organization
Organization Name:ZIA HEARING CENTER, LLC
Other - Org Name:SANDIA HEARING AIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEARING AID DISPENSER/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:505-326-2791
Mailing Address - Street 1:4001 N BUTLER AVE STE 5101
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-2392
Mailing Address - Country:US
Mailing Address - Phone:505-326-2791
Mailing Address - Fax:
Practice Address - Street 1:4001 N BUTLER AVE STE 5101
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-2392
Practice Address - Country:US
Practice Address - Phone:505-326-2791
Practice Address - Fax:505-564-2811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1306354931Medicaid