Provider Demographics
NPI:1871668970
Name:CHENAULT HOUSE OF HEARING, INC
Entity Type:Organization
Organization Name:CHENAULT HOUSE OF HEARING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:CHENAULT
Authorized Official - Suffix:
Authorized Official - Credentials:AUDIOPROSTHOLOGIST
Authorized Official - Phone:903-455-5424
Mailing Address - Street 1:2112 STONEWALL ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-3344
Mailing Address - Country:US
Mailing Address - Phone:903-455-5424
Mailing Address - Fax:903-455-8922
Practice Address - Street 1:2112 STONEWALL ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-3344
Practice Address - Country:US
Practice Address - Phone:903-455-5424
Practice Address - Fax:903-455-8922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50067237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX528263OtherBLUE CROSS BLUE SHIELD
TX022438801Medicaid
TX1225007107OtherNPI - INDIVIDUAL