Provider Demographics
NPI:1669751335
Name:MONTGOMERY AUDIOLOGY AND HEARING AIDS
Entity type:Organization
Organization Name:MONTGOMERY AUDIOLOGY AND HEARING AIDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BILES ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC/A
Authorized Official - Phone:936-447-3277
Mailing Address - Street 1:18001 HWY. 105 WEST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356
Mailing Address - Country:US
Mailing Address - Phone:936-447-3277
Mailing Address - Fax:936-447-3279
Practice Address - Street 1:18001 HWY. 105 WEST
Practice Address - Street 2:SUITE 101
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356
Practice Address - Country:US
Practice Address - Phone:936-447-3277
Practice Address - Fax:936-447-3279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX237600000X231H00000X, 231HA2400X, 231HA2500X, 237600000X, 237700000X
TX50317237700000X, 237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology PractitionerGroup - Multi-Specialty
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology SupplierGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112791203Medicaid
TX515965Medicare PIN