Provider Demographics
NPI:1497959134
Name:AUDIOLOGY ASSOCIATES OF EAST TEXAS, INC
Entity Type:Organization
Organization Name:AUDIOLOGY ASSOCIATES OF EAST TEXAS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:TWOMEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-592-8374
Mailing Address - Street 1:1018 PRUITT PL
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-1132
Mailing Address - Country:US
Mailing Address - Phone:903-592-8374
Mailing Address - Fax:903-592-5293
Practice Address - Street 1:1018 PRUITT PL
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1132
Practice Address - Country:US
Practice Address - Phone:903-592-8374
Practice Address - Fax:903-592-5293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50199231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0003DLOtherBCBS TX GROUP ID
TX0003DLOtherBCBS TX GROUP ID