Provider Demographics
NPI:1639498306
Name:JAG HOUSTON, INC.
Entity Type:Organization
Organization Name:JAG HOUSTON, INC.
Other - Org Name:MIRACLE-EAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:GUEST
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:404-444-7207
Mailing Address - Street 1:1533 W BAY AREA BLVD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-3400
Mailing Address - Country:US
Mailing Address - Phone:281-338-2394
Mailing Address - Fax:218-316-1353
Practice Address - Street 1:1533 W BAY AREA BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-3400
Practice Address - Country:US
Practice Address - Phone:281-338-2394
Practice Address - Fax:218-316-1353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADS000830332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment