Healthcare Provider Details

I. General information

NPI: 1144536806
Provider Name (Legal Business Name): ANDERSON AUDIOLOGY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2010
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 NORWOOD DR SUITE 100
HURST TX
76054-3646
US

IV. Provider business mailing address

PO BOX 1258
HURST TX
76053-1258
US

V. Phone/Fax

Practice location:
  • Phone: 817-282-8402
  • Fax: 817-285-6182
Mailing address:
  • Phone: 817-282-8402
  • Fax: 817-285-6182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number50913
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number50913
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number50913
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number50913
License Number StateTX

VIII. Authorized Official

Name: RENAE FOWLER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 817-282-8402