Provider Demographics
NPI:1811406630
Name:SOUTHERN COLORADO HEARING ASSOCIATES, INC.
Entity Type:Organization
Organization Name:SOUTHERN COLORADO HEARING ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRAE
Authorized Official - Middle Name:CHRISTINA
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:719-252-9909
Mailing Address - Street 1:5936 REBA CT
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-8708
Mailing Address - Country:US
Mailing Address - Phone:719-252-9909
Mailing Address - Fax:
Practice Address - Street 1:904 EAST HAILEY LANE
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007
Practice Address - Country:US
Practice Address - Phone:719-252-9909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-25
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO353231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty