Provider Demographics
NPI:1134148729
Name:NORTH EAST SAN ANTONIO HEARING & BALANCE L.L.C.
Entity type:Organization
Organization Name:NORTH EAST SAN ANTONIO HEARING & BALANCE L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LIVELL
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:210-653-1722
Mailing Address - Street 1:12413 JUDSON RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3215
Mailing Address - Country:US
Mailing Address - Phone:210-653-1722
Mailing Address - Fax:210-653-1742
Practice Address - Street 1:12413 JUDSON RD. STE.200
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233
Practice Address - Country:US
Practice Address - Phone:210-653-1722
Practice Address - Fax:210-653-1742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTH006Medicare ID - Type UnspecifiedIDTF