Provider Demographics
NPI:1639200918
Name:SANDIA HEARING AIDS
Entity Type:Organization
Organization Name:SANDIA HEARING AIDS
Other - Org Name:PAUL WEBER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MQNAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:CELESTE
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:505-523-0267
Mailing Address - Street 1:2001 E LOHMAN AVE
Mailing Address - Street 2:STE. #134
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-3167
Mailing Address - Country:US
Mailing Address - Phone:505-523-0267
Mailing Address - Fax:505-523-6408
Practice Address - Street 1:2001 E LOHMAN AVE
Practice Address - Street 2:STE. #134
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3167
Practice Address - Country:US
Practice Address - Phone:505-523-0267
Practice Address - Fax:505-523-6408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM553237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNMTB0037OtherBLUE CROSS AND BLUE SHIEL