Provider Demographics
NPI:1891151569
Name:CONCIERGE AUDIOLOGY
Entity Type:Organization
Organization Name:CONCIERGE AUDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCANN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:832-954-9549
Mailing Address - Street 1:12680 W LAKE HOUSTON PKWY
Mailing Address - Street 2:SUITE 501, BOX 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77044-6087
Mailing Address - Country:US
Mailing Address - Phone:832-954-9549
Mailing Address - Fax:
Practice Address - Street 1:12680 W LAKE HOUSTON PKWY
Practice Address - Street 2:SUITE 501, BOX 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77044-6087
Practice Address - Country:US
Practice Address - Phone:832-954-9549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80460332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment