Provider Demographics
NPI:1063050383
Name:SANDIA HEARING SANTA FE, LLC
Entity type:Organization
Organization Name:SANDIA HEARING SANTA FE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LONGTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-799-2852
Mailing Address - Street 1:3454 ZAFARANO DR STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-2667
Mailing Address - Country:US
Mailing Address - Phone:505-988-1984
Mailing Address - Fax:503-474-3078
Practice Address - Street 1:3454 ZAFARANO DR STE B
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-2667
Practice Address - Country:US
Practice Address - Phone:505-988-1984
Practice Address - Fax:503-474-3078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty