Provider Demographics
NPI:1134592744
Name:FW HEARING LLC
Entity type:Organization
Organization Name:FW HEARING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-439-9205
Mailing Address - Street 1:4823 CAMP BOWIE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-4150
Mailing Address - Country:US
Mailing Address - Phone:817-439-9205
Mailing Address - Fax:
Practice Address - Street 1:4823 CAMP BOWIE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-4150
Practice Address - Country:US
Practice Address - Phone:817-439-9205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50913261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech