Provider Demographics
NPI:1326407792
Name:COPLEY HEARING CENTER LLC DBA TOTAL HEARING CARE
Entity Type:Organization
Organization Name:COPLEY HEARING CENTER LLC DBA TOTAL HEARING CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:COPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:512-657-6243
Mailing Address - Street 1:4130 ABRAMS RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-2607
Mailing Address - Country:US
Mailing Address - Phone:214-827-1900
Mailing Address - Fax:
Practice Address - Street 1:4130 ABRAMS RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-2607
Practice Address - Country:US
Practice Address - Phone:214-827-1900
Practice Address - Fax:214-821-8106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51258237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX465167OtherMEDICARE PTAN