Provider Demographics
NPI:1609190628
Name:INCUS HEARING LLC
Entity Type:Organization
Organization Name:INCUS HEARING LLC
Other - Org Name:INCUS HEARING SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:FARIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:956-534-3837
Mailing Address - Street 1:702 E GRIFFIN PKWY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2918
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:702 E GRIFFIN PKWY
Practice Address - Street 2:SUITE 4
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2918
Practice Address - Country:US
Practice Address - Phone:956-534-3837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51306237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty