Provider Demographics
NPI:1316107600
Name:ZUNI AUDIOLOGY PROGRAM
Entity type:Organization
Organization Name:ZUNI AUDIOLOGY PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRIBAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AVA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNAWEEKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-782-7000
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:ZUNI
Mailing Address - State:NM
Mailing Address - Zip Code:87327-0339
Mailing Address - Country:US
Mailing Address - Phone:505-782-7233
Mailing Address - Fax:505-782-7241
Practice Address - Street 1:1203B STATE HWY 53
Practice Address - Street 2:
Practice Address - City:ZUNI
Practice Address - State:NM
Practice Address - Zip Code:87327
Practice Address - Country:US
Practice Address - Phone:505-782-7233
Practice Address - Fax:505-782-7241
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PUEBLO OF ZUNI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-11
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM96083867Medicaid