1316167620 NPI number — K J GORMAN, LLC

Table of content: (NPI 1316167620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316167620 NPI number — K J GORMAN, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
K J GORMAN, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AUDIBEL HEARING AID CENTERS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316167620
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
267 WYNNEWOOD VILLAGE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-948-3273
Provider Business Mailing Address Fax Number:
214-942-4114

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
267 WYNNEWOOD VILLAGE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-948-3273
Provider Business Practice Location Address Fax Number:
214-942-4114
Provider Enumeration Date:
04/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GORMAN
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
214-948-3273

Provider Taxonomy Codes

  • Taxonomy code: 237600000X , with the licence number:  51598 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 80405A . This is a "INDIVIDUAL NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 180691101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0090MX . This is a "BLUE CROSS OF TEXAS GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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