Provider Demographics
NPI:1942404181
Name:MARTIN E MCGONAGLE MD PA
Entity Type:Organization
Organization Name:MARTIN E MCGONAGLE MD PA
Other - Org Name:MIDTEX HEARING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCGONAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:817-579-2660
Mailing Address - Street 1:510 E HWY 377
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-2556
Mailing Address - Country:US
Mailing Address - Phone:817-579-2662
Mailing Address - Fax:817-579-2663
Practice Address - Street 1:510 E HWY 377
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-2556
Practice Address - Country:US
Practice Address - Phone:817-579-2662
Practice Address - Fax:817-579-2663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX531541OtherBCBS
TXB24744Medicare UPIN
TX531541OtherBCBS