Provider Demographics
NPI:1093846248
Name:EAR INSTITUTE OF TEXAS P A
Entity Type:Organization
Organization Name:EAR INSTITUTE OF TEXAS P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-696-4327
Mailing Address - Street 1:18518 HARDY OAK BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4271
Mailing Address - Country:US
Mailing Address - Phone:210-696-4327
Mailing Address - Fax:210-798-2509
Practice Address - Street 1:18518 HARDY OAK BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4271
Practice Address - Country:US
Practice Address - Phone:210-696-4327
Practice Address - Fax:210-798-2509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5777174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0036JVOtherBLUE SHIELD
TXP00019999OtherMEDICARE RAILROAD
TX157517701Medicaid
TXP00019999OtherMEDICARE RAILROAD