Provider Demographics
NPI:1568639300
Name:AUDIOLOGY CARE GROUP, INC
Entity Type:Organization
Organization Name:AUDIOLOGY CARE GROUP, INC
Other - Org Name:BELTONE AUDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF AUDIOLOGY/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FAIN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:832-618-1010
Mailing Address - Street 1:1509B W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1533
Mailing Address - Country:US
Mailing Address - Phone:832-618-1010
Mailing Address - Fax:832-838-4232
Practice Address - Street 1:1509B W 18TH ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1533
Practice Address - Country:US
Practice Address - Phone:832-618-1010
Practice Address - Fax:832-838-4232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51161237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX531239OtherBLUE CROSS/BLUE SHIELD
TX531239OtherBLUE CROSS/BLUE SHIELD