Provider Demographics
NPI:1639304363
Name:CHARLES W BEATTY JR
Entity Type:Organization
Organization Name:CHARLES W BEATTY JR
Other - Org Name:BEATTY AUDIOLOGY AND HEARING AIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BEATTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-757-4083
Mailing Address - Street 1:1101 PEGUES PL
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-4031
Mailing Address - Country:US
Mailing Address - Phone:903-757-4083
Mailing Address - Fax:903-757-4083
Practice Address - Street 1:102 TERESE DR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-6156
Practice Address - Country:US
Practice Address - Phone:903-757-4083
Practice Address - Fax:903-757-4083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50322237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty