| |
1217 S Broadway St Ste N, Sulphur Springs, TX 75482-4888 | |
(903) 438-1600 | |
(903) 438-1627 |
Full Name | |
---|---|
Type | Facility |
Speciality | Audiologist |
Location | 1217 S Broadway St Ste N, Sulphur Springs, Texas |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1538393707 | NPI | - | NPPES |
089238201 | Medicaid | TX | |
089238202 | Medicaid | TX | |
198911901 | Medicaid | TX | |
089238203 | Medicaid | TX | |
198911902 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
231H00000X | Audiologist | 50734 (Texas) | Primary |
235Z00000X | Speech-language Pathologist | 14561 (Texas) | Secondary |
237600000X | Audiologist-hearing Aid Fitter | 80263 (Texas) | Secondary |
Mailing Address | Practice Location Address |
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1217 S Broadway St Ste N, Sulphur Springs, TX 75482-4888 Ph: (903) 438-1600 | 1217 S Broadway St Ste N, Sulphur Springs, TX 75482-4888 Ph: (903) 438-1600 |