Basic Information
| Provider Information | |||||||||
| NPI: | 1205205648 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PUEBLO HEARING AIDS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 W 6TH ST | ||||||||
| Address2: | STE H | ||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810032316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195432116 | ||||||||
| FaxNumber: | 7195432216 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 W 6TH ST | ||||||||
| Address2: | STE H | ||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810032316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195432116 | ||||||||
| FaxNumber: | 7195432216 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2015 | ||||||||
| LastUpdateDate: | 09/16/2015 | ||||||||
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| AuthorizedOfficialLastName: | STOCKTON | ||||||||
| AuthorizedOfficialFirstName: | SHAD | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7192761082 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332S00000X | Y | Suppliers | Hearing Aid Equipment |
No ID Information.