Provider Demographics
NPI:1295859916
Name:ADVANCED HEARING AID CENTER
Entity Type:Organization
Organization Name:ADVANCED HEARING AID CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:817-332-8817
Mailing Address - Street 1:904 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2225
Mailing Address - Country:US
Mailing Address - Phone:817-332-8817
Mailing Address - Fax:817-332-8827
Practice Address - Street 1:904 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2225
Practice Address - Country:US
Practice Address - Phone:817-332-8817
Practice Address - Fax:817-332-8827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment