Healthcare Provider's Profile
| Full Name | |
|---|
| Type | Facility |
|---|
| Speciality | Hearing Aid Equipment |
|---|
| Location | 5512 Bellaire Dr S Ste K, Fort Worth, Texas |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1124294863
- Provider Enumeration Date: 05/02/2008
- Last Update Date: 06/13/2023
Medical Identifiers
Medical identifiers for
such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1124294863 | NPI | - | NPPES |
| 530294 | Other | TX | BCBS |
| 112774801 | Medicaid | TX | |
| 0615164 | Other | TX | AETNA |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 231H00000X | Audiologist | (* (Not Available)) | Secondary |
| 231HA2400X | Audiologist - Assistive Technology Practitioner | (* (Not Available)) | Secondary |
| 231HA2500X | Audiologist - Assistive Technology Supplier | (* (Not Available)) | Secondary |
| 237600000X | Audiologist-hearing Aid Fitter | (* (Not Available)) | Secondary |
| 237700000X | Hearing Instrument Specialist | (* (Not Available)) | Secondary |
| 332S00000X | Hearing Aid Equipment | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. is NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
750 N Commons Dr Ste 200,
Aurora, IL 60504-7940
Ph: (630) 303-5380 |
5512 Bellaire Dr S Ste K,
Fort Worth, TX 76109-5800
Ph: (817) 546-0514 |
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