1336581750 NPI number — BAXTER HEARING SPECIALISTS, L.L.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336581750 NPI number — BAXTER HEARING SPECIALISTS, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAXTER HEARING SPECIALISTS, L.L.C.
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:
Provider Other Organization Name Type Code:
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:
1336581750
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1211 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEATHERFORD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76086-5526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-613-8740
Provider Business Mailing Address Fax Number:
817-341-6455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6353 CAMP BOWIE BLVD
Provider Second Line Business Practice Location Address:
SUITE 113
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76116-5482
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-763-0863
Provider Business Practice Location Address Fax Number:
817-731-3692
Provider Enumeration Date:
07/26/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BAXTER
Authorized Official First Name:
CHASE
Authorized Official Middle Name:
RYAN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
972-689-0524

Provider Taxonomy Codes

  • Taxonomy code: 332S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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