Provider Demographics
NPI:1245486257
Name:THE HEARING GROUP OF NEW MEXICO, LLC
Entity type:Organization
Organization Name:THE HEARING GROUP OF NEW MEXICO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-A
Authorized Official - Phone:505-247-4466
Mailing Address - Street 1:2060 MAIN ST NE STE A
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-6368
Mailing Address - Country:US
Mailing Address - Phone:505-247-4466
Mailing Address - Fax:505-796-4722
Practice Address - Street 1:2060 MAIN ST NE STE A
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-6368
Practice Address - Country:US
Practice Address - Phone:505-247-4466
Practice Address - Fax:505-247-4472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-09
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3541231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM71530274Medicaid
NM71530274Medicaid