Provider Demographics
NPI:1639249337
Name:DOCTORS HEARING CENTER LLC XXXIII
Entity Type:Organization
Organization Name:DOCTORS HEARING CENTER LLC XXXIII
Other - Org Name:DOCTORS TESTING CENTER LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:P
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-985-9944
Mailing Address - Street 1:2227 WEST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076
Mailing Address - Country:US
Mailing Address - Phone:501-985-9944
Mailing Address - Fax:501-985-6590
Practice Address - Street 1:8039 LINE AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106
Practice Address - Country:US
Practice Address - Phone:800-700-2771
Practice Address - Fax:877-835-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LASCH58Medicare ID - Type Unspecified
IDTFMedicare UPIN