Provider Demographics
NPI:1780805697
Name:HILL COUNTRY AUDIOLOGY
Entity type:Organization
Organization Name:HILL COUNTRY AUDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNELL
Authorized Official - Suffix:
Authorized Official - Credentials:AUD CCC-A
Authorized Official - Phone:512-763-8855
Mailing Address - Street 1:375 TWIN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-4371
Mailing Address - Country:US
Mailing Address - Phone:512-763-8855
Mailing Address - Fax:
Practice Address - Street 1:100 RIVER HILLS DR
Practice Address - Street 2:STE 105
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-2764
Practice Address - Country:US
Practice Address - Phone:512-763-8855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50953231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112794602Medicaid
TX580068Medicare ID - Type Unspecified
TX8L13901Medicare PIN