Provider Demographics
NPI:1619252244
Name:MD LIFETIME HEARING CARE CENTERS, INC
Entity Type:Organization
Organization Name:MD LIFETIME HEARING CARE CENTERS, INC
Other - Org Name:LIFETIME HEARING AIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MUSA
Authorized Official - Middle Name:
Authorized Official - Last Name:JUDEH
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:817-656-8600
Mailing Address - Street 1:2905 BROWN TRAIL
Mailing Address - Street 2:SUITE Q
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021
Mailing Address - Country:US
Mailing Address - Phone:817-656-8600
Mailing Address - Fax:817-656-8602
Practice Address - Street 1:2905 BROWN TRAIL
Practice Address - Street 2:SUITE # Q
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021
Practice Address - Country:US
Practice Address - Phone:817-656-8600
Practice Address - Fax:817-656-8602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-14
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80498237700000X, 237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX287446301Medicaid
TX2874463OtherMEDICAID
TX533189OtherBLUE CROSS