Provider Demographics
NPI:1073942140
Name:BAXTER HEARING SPECIALISTS
Entity Type:Organization
Organization Name:BAXTER HEARING SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-717-0554
Mailing Address - Street 1:6600 SANGER AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-7817
Mailing Address - Country:US
Mailing Address - Phone:254-751-9599
Mailing Address - Fax:254-751-9715
Practice Address - Street 1:6600 SANGER AVE STE 11
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-7817
Practice Address - Country:US
Practice Address - Phone:254-751-9599
Practice Address - Fax:254-751-9715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80296332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment