Provider Demographics
NPI:1235676529
Name:J K MANGREM
Entity Type:Organization
Organization Name:J K MANGREM
Other - Org Name:HOLLAND HEARING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KELSI
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGREM
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:325-437-4730
Mailing Address - Street 1:7 HOSPITAL DR.
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606
Mailing Address - Country:US
Mailing Address - Phone:325-437-4730
Mailing Address - Fax:
Practice Address - Street 1:7 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5269
Practice Address - Country:US
Practice Address - Phone:325-437-4730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80588231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty