Provider Demographics
NPI:1164533246
Name:EAR MEDICAL GROUP PA
Entity Type:Organization
Organization Name:EAR MEDICAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:AUGUSTINE
Authorized Official - Last Name:SYMS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:210-614-6070
Mailing Address - Street 1:21 SPURS LANE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240
Mailing Address - Country:US
Mailing Address - Phone:210-614-6070
Mailing Address - Fax:210-615-6814
Practice Address - Street 1:21 SPURS LANE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240
Practice Address - Country:US
Practice Address - Phone:210-614-6070
Practice Address - Fax:210-615-6814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207YX0901X
TX0080928503231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & NeurotologyGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112782101Medicaid
TX00CT80Medicare PIN