Provider Demographics
NPI:1184706244
Name:FIVE G'S ADVANCED HEARING, LTD.
Entity type:Organization
Organization Name:FIVE G'S ADVANCED HEARING, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/HEARING INSTRUMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:GLEASON
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:806-355-9957
Mailing Address - Street 1:3801 OLSEN BLVD UNIT 6
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-3070
Mailing Address - Country:US
Mailing Address - Phone:806-355-9957
Mailing Address - Fax:806-356-9963
Practice Address - Street 1:3801 OLSEN BLVD UNIT 6
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-3070
Practice Address - Country:US
Practice Address - Phone:806-355-9957
Practice Address - Fax:806-356-9963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151217001Medicaid