Provider Demographics
NPI:1790919496
Name:ON-SITE AUDIOLOGY TX, LLC
Entity Type:Organization
Organization Name:ON-SITE AUDIOLOGY TX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-443-0043
Mailing Address - Street 1:16095 PROSPERITY DR
Mailing Address - Street 2:STE. 300
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-4319
Mailing Address - Country:US
Mailing Address - Phone:371-219-3456
Mailing Address - Fax:888-400-2221
Practice Address - Street 1:16095 PROSPERITY DR
Practice Address - Street 2:SUITE 300
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-4319
Practice Address - Country:US
Practice Address - Phone:317-219-3456
Practice Address - Fax:888-400-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-08
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001256A231H00000X, 237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty