Provider Demographics
NPI:1164074126
Name:EAST TEXAS HEARING AIDS, LLC
Entity Type:Organization
Organization Name:EAST TEXAS HEARING AIDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/HEARING INSTRUMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JUSTIN
Authorized Official - Last Name:ROACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-630-5600
Mailing Address - Street 1:4411 OLD BULLARD RD STE 501
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-1215
Mailing Address - Country:US
Mailing Address - Phone:903-630-5600
Mailing Address - Fax:903-630-5601
Practice Address - Street 1:4411 OLD BULLARD RD STE 501
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1215
Practice Address - Country:US
Practice Address - Phone:903-630-5600
Practice Address - Fax:903-630-5601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty