Provider Demographics
NPI:1992928311
Name:COLORADO WEST HEARING SERVICES-AAA HEARING SERVICE
Entity type:Organization
Organization Name:COLORADO WEST HEARING SERVICES-AAA HEARING SERVICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUJAN
Authorized Official - Suffix:
Authorized Official - Credentials:NBC-HIS
Authorized Official - Phone:970-243-6440
Mailing Address - Street 1:2532 PATTERSON RD
Mailing Address - Street 2:SUITE #12
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1099
Mailing Address - Country:US
Mailing Address - Phone:970-243-6440
Mailing Address - Fax:970-242-2250
Practice Address - Street 1:2532 PATTERSON RD
Practice Address - Street 2:SUITE #12
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1099
Practice Address - Country:US
Practice Address - Phone:970-243-6440
Practice Address - Fax:970-242-2250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO133237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04017836Medicaid
CO2833Medicare ID - Type Unspecified