Provider Demographics
NPI:1720425523
Name:HEARING AID STORE, INC
Entity Type:Organization
Organization Name:HEARING AID STORE, INC
Other - Org Name:THE HEARING AID STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:BURT
Authorized Official - Last Name:BLAGG
Authorized Official - Suffix:
Authorized Official - Credentials:HIS, HAD
Authorized Official - Phone:505-299-7777
Mailing Address - Street 1:8400 MENAUL BLVD NE
Mailing Address - Street 2:SUITE F
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2260
Mailing Address - Country:US
Mailing Address - Phone:505-299-7777
Mailing Address - Fax:505-299-7777
Practice Address - Street 1:8400 MENAUL BLVD NE
Practice Address - Street 2:SUITE F
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2260
Practice Address - Country:US
Practice Address - Phone:505-299-7777
Practice Address - Fax:505-299-7777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0832261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech