Provider Demographics
NPI:1356525232
Name:MONTEZUMA HEARING CLINIC, INC.
Entity type:Organization
Organization Name:MONTEZUMA HEARING CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF AUDIOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ARRIOLA-STORY
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:970-565-4655
Mailing Address - Street 1:892 COTTONWOOD ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-2200
Mailing Address - Country:US
Mailing Address - Phone:970-565-4655
Mailing Address - Fax:970-238-2630
Practice Address - Street 1:892 COTTONWOOD ST STE 2
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-2200
Practice Address - Country:US
Practice Address - Phone:970-565-4655
Practice Address - Fax:970-238-2630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO343231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO92804349Medicaid
CO92804349Medicaid