1114193109 NPI number — JACK JONES HEARING AID CENTERS INS

Table of content: (NPI 1114193109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114193109 NPI number — JACK JONES HEARING AID CENTERS INS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JACK JONES HEARING AID CENTERS INS
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:
JONES HEARING AID CENTER
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:
1114193109
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 S HENDERSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76104-1017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-335-2583
Provider Business Mailing Address Fax Number:
817-335-2597

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1719 S LOOP 288
Provider Second Line Business Practice Location Address:
SUITE 165
Provider Business Practice Location Address City Name:
DENTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76205-4809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-566-2425
Provider Business Practice Location Address Fax Number:
940-566-2469
Provider Enumeration Date:
04/30/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
IRENE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
817-348-8563

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0615164 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 112774802 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 530294 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".