Provider Demographics
NPI:1881026649
Name:PRO ACTIVE HEARING LLC
Entity Type:Organization
Organization Name:PRO ACTIVE HEARING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:HAD
Authorized Official - Phone:575-622-0375
Mailing Address - Street 1:214 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88203-4602
Mailing Address - Country:US
Mailing Address - Phone:575-622-0375
Mailing Address - Fax:575-622-0575
Practice Address - Street 1:214 W 1ST ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-4602
Practice Address - Country:US
Practice Address - Phone:575-622-0375
Practice Address - Fax:575-622-0575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-04
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4684745332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment