Provider Demographics
NPI:1073611646
Name:MAXEAR, INC.
Entity Type:Organization
Organization Name:MAXEAR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:MANGIAMELE
Authorized Official - Suffix:
Authorized Official - Credentials:AUDIOPROSTHOLOGIST
Authorized Official - Phone:512-308-9999
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-0209
Mailing Address - Country:US
Mailing Address - Phone:512-308-9999
Mailing Address - Fax:512-308-9998
Practice Address - Street 1:3971 HIGHWAY 71 E
Practice Address - Street 2:107
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-5121
Practice Address - Country:US
Practice Address - Phone:512-308-9999
Practice Address - Fax:512-308-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50586174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty