Provider Demographics
NPI:1619173515
Name:HEARTECH, L.L.C.
Entity Type:Organization
Organization Name:HEARTECH, L.L.C.
Other - Org Name:MIRACLE-EAR HEARING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:E
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:HEARING AID SPECIALI
Authorized Official - Phone:817-763-9991
Mailing Address - Street 1:6500 CAMP BOWIE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-4352
Mailing Address - Country:US
Mailing Address - Phone:817-763-9991
Mailing Address - Fax:817-763-9994
Practice Address - Street 1:6500 CAMP BOWIE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-4352
Practice Address - Country:US
Practice Address - Phone:817-763-9991
Practice Address - Fax:817-763-9994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50309237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty