1376673418 NPI number — ESTES AUDIOLOGY PA

Table of content: (NPI 1376673418)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376673418 NPI number — ESTES AUDIOLOGY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ESTES AUDIOLOGY PA
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:
ESTES AUDIOLOGY HEARING CENTER
Provider Other Organization Name Type Code:
5
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:
1376673418
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1528 COMMON ST
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
NEW BRAUNFELS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78130-3113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-643-0033
Provider Business Mailing Address Fax Number:
830-643-0350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1529 COMMON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BRAUNFELS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-643-0033
Provider Business Practice Location Address Fax Number:
830-643-0350
Provider Enumeration Date:
03/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OENNING
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
830-643-0033

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  51386 , 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: 81MJ . This is a "BCBS GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 7372704 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: DD8570 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1765976 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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