Provider Demographics
NPI:1497962302
Name:TEXAS PROFESSIONAL HEARING CENTER INC
Entity Type:Organization
Organization Name:TEXAS PROFESSIONAL HEARING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:281-420-8033
Mailing Address - Street 1:234 W CEDAR BAYOU LYNCHBURG RD
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-9051
Mailing Address - Country:US
Mailing Address - Phone:281-420-8033
Mailing Address - Fax:281-420-8057
Practice Address - Street 1:234 W CEDAR BAYOU LYNCHBURG RD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-9051
Practice Address - Country:US
Practice Address - Phone:281-420-8033
Practice Address - Fax:281-420-8057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145676603Medicaid
TX145676603Medicaid