Provider Demographics
NPI:1265844369
Name:CLC HEARING CENTERS, LLC.
Entity Type:Organization
Organization Name:CLC HEARING CENTERS, LLC.
Other - Org Name:AMERICAN HEARING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CALMONY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-774-7727
Mailing Address - Street 1:1618 CANYON CREEK DR STE 140
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-3273
Mailing Address - Country:US
Mailing Address - Phone:254-774-7727
Mailing Address - Fax:254-771-1256
Practice Address - Street 1:1618 CANYON CREEK DR STE 140
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-3273
Practice Address - Country:US
Practice Address - Phone:254-774-7727
Practice Address - Fax:254-771-1256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50228231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1452823-01Medicaid
TX1452823-03Medicaid
TX1452823-02Medicaid
TX1452823-03Medicaid