Provider Demographics
NPI:1326296476
Name:NEWPORT AUDIOLOGY CENTERS
Entity Type:Organization
Organization Name:NEWPORT AUDIOLOGY CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:AUD, CCC-A
Authorized Official - Phone:1800-675-5485
Mailing Address - Street 1:5990 GREENWOOD PLAZA BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4704
Mailing Address - Country:US
Mailing Address - Phone:800-675-5485
Mailing Address - Fax:
Practice Address - Street 1:1550 W ROSEDALE ST
Practice Address - Street 2:SUITE 208
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7438
Practice Address - Country:US
Practice Address - Phone:800-675-5485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80166231H00000X
AZDA5932231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty