Provider Demographics
NPI:1831509900
Name:ELITE AUDIOLOGY RESOURCES, PLLC
Entity type:Organization
Organization Name:ELITE AUDIOLOGY RESOURCES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BADSTUBNER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:352-672-5357
Mailing Address - Street 1:578 N KIMBALL AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6883
Mailing Address - Country:US
Mailing Address - Phone:817-778-4934
Mailing Address - Fax:817-380-3256
Practice Address - Street 1:578 N KIMBALL AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6883
Practice Address - Country:US
Practice Address - Phone:817-778-4934
Practice Address - Fax:817-380-3256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80477231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX362902ZH8SOtherMEDICARE
TX362901OtherMEDICARE