Provider Demographics
NPI:1710936836
Name:LIVINGSTON HEARING AID CENTER, INC.
Entity Type:Organization
Organization Name:LIVINGSTON HEARING AID CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAVILA
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:806-799-8950
Mailing Address - Street 1:5303 50TH STREET
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414
Mailing Address - Country:US
Mailing Address - Phone:806-799-8950
Mailing Address - Fax:806-792-9404
Practice Address - Street 1:5303 50TH STREET
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414
Practice Address - Country:US
Practice Address - Phone:806-799-8950
Practice Address - Fax:806-792-9404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
231H00000X, 237700000X
TX237600000X
TX50044332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX530529OtherBLUE CROSS BLUE SHIELD
TX094569302Medicaid
TX094569302Medicaid