Provider Demographics
NPI:1962439257
Name:CEDAR CREEK HEARING CENTER
Entity Type:Organization
Organization Name:CEDAR CREEK HEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:JOESPH
Authorized Official - Last Name:ROESER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-432-1932
Mailing Address - Street 1:601 S TOOL DR
Mailing Address - Street 2:
Mailing Address - City:KEMP
Mailing Address - State:TX
Mailing Address - Zip Code:75143-1959
Mailing Address - Country:US
Mailing Address - Phone:903-432-1932
Mailing Address - Fax:
Practice Address - Street 1:601 S TOOL DR
Practice Address - Street 2:
Practice Address - City:KEMP
Practice Address - State:TX
Practice Address - Zip Code:75143-1959
Practice Address - Country:US
Practice Address - Phone:903-432-1932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50234237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1=========3000Medicaid