Provider Demographics
NPI:1750330882
Name:ELDER EAR MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:ELDER EAR MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HARLAN
Authorized Official - Middle Name:REXMAN
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-594-8323
Mailing Address - Street 1:415 E AIRPORT FWY
Mailing Address - Street 2:SUITE #240
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-6319
Mailing Address - Country:US
Mailing Address - Phone:972-594-8323
Mailing Address - Fax:972-594-8329
Practice Address - Street 1:415 E AIRPORT FWY
Practice Address - Street 2:SUITE #240
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-6319
Practice Address - Country:US
Practice Address - Phone:972-594-8323
Practice Address - Fax:972-594-8329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00459ZMedicare PIN
CAW15132Medicare PIN
CAZZZ32539ZMedicare PIN