Basic Information
| Provider Information | |||||||||
| NPI: | 1205155280 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MESILLA VALLEY HEARING AID CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 13172 | ||||||||
| Address2: | |||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880133172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5759935225 | ||||||||
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| Practice Location | |||||||||
| Address1: | 225 E IDAHO AVE | ||||||||
| Address2: | SUITE 24 | ||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880053257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755269091 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2010 | ||||||||
| LastUpdateDate: | 05/30/2010 | ||||||||
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| AuthorizedOfficialLastName: | MITCHELL | ||||||||
| AuthorizedOfficialFirstName: | ANN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5759935225 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332S00000X | 13499-NM | NM | Y | Suppliers | Hearing Aid Equipment |
No ID Information.