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150 Willow Creek Dr Ste 105, Weatherford, TX 76085-3652 | |
(817) 550-6115 | |
(866) 358-6404 |
Full Name | |
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Type | Facility |
Speciality | Audiologist-hearing Aid Fitter |
Location | 150 Willow Creek Dr Ste 105, Weatherford, Texas |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1619217411 | NPI | - | NPPES |
TXB114970 | Other | TX | MEDICARE PTAN |
280916203 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
231H00000X | Audiologist | 51498 (Texas) | Secondary |
237600000X | Audiologist-hearing Aid Fitter | 51498 (Texas) | Primary |
Provider Name | Terri Jo Edwards |
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Provider Type | Practitioner - Qualified Audiologist |
Provider Identifiers | NPI Number: 1205097128 PECOS PAC ID: 8325236599 Enrollment ID: I20110103000957 |
Provider Name | Julie Mistic |
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Provider Type | Practitioner - Qualified Audiologist |
Provider Identifiers | NPI Number: 1578827986 PECOS PAC ID: 3870749492 Enrollment ID: I20120813000812 |
Provider Name | Liana Elise Mills |
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Provider Type | Practitioner - Qualified Audiologist |
Provider Identifiers | NPI Number: 1033685235 PECOS PAC ID: 9335486240 Enrollment ID: I20190131000888 |
Mailing Address | Practice Location Address |
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150 Willow Creek Dr Ste 105, Weatherford, TX 76085-3652 Ph: (817) 550-6115 | 150 Willow Creek Dr Ste 105, Weatherford, TX 76085-3652 Ph: (817) 550-6115 |