1851622062 NPI number — PEB ENTERPRISES INC

Table of content: (NPI 1851622062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851622062 NPI number — PEB ENTERPRISES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEB ENTERPRISES INC
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:
AMERICAN HEARING LABORATORIES
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:
1851622062
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
959 W CENTERVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75041-5824
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-681-6419
Provider Business Mailing Address Fax Number:
972-681-2582

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3600 FM 2181
Provider Second Line Business Practice Location Address:
STE 300
Provider Business Practice Location Address City Name:
HICKORY CREEK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75065-7636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-321-1311
Provider Business Practice Location Address Fax Number:
940-497-1374
Provider Enumeration Date:
01/28/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BERRY
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
DIRECTOR OF FINANCE
Authorized Official Telephone Number:
940-321-1311

Provider Taxonomy Codes

  • Taxonomy code: 237600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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