Provider Demographics
NPI:1073709051
Name:FAMILY AUDIOLOGY
Entity Type:Organization
Organization Name:FAMILY AUDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:972-943-0466
Mailing Address - Street 1:4105 W SPRING CREEK PKWY STE 702
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-5301
Mailing Address - Country:US
Mailing Address - Phone:972-943-0466
Mailing Address - Fax:972-599-1707
Practice Address - Street 1:4105 W SPRING CREEK PKWY STE 702
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-5301
Practice Address - Country:US
Practice Address - Phone:972-943-0466
Practice Address - Fax:972-599-1707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51713237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00721ZMedicare PIN