Healthcare Provider Details

I. General information

NPI: 1356691208
Provider Name (Legal Business Name): MARTIN AUDIOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 W UNIVERSITY AVE STE. 122
GEORGETOWN TX
78628-5340
US

IV. Provider business mailing address

203 TWISTED OAK LN
CRAWFORD TX
76638-2896
US

V. Phone/Fax

Practice location:
  • Phone: 512-868-1100
  • Fax: 512-868-1105
Mailing address:
  • Phone: 254-537-4426
  • Fax: 254-300-4619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number11150
License Number StateTX

VIII. Authorized Official

Name: STEVE KEY
Title or Position: MEMBER
Credential:
Phone: 254-537-4426