Healthcare Provider Details

I. General information

NPI: 1831353044
Provider Name (Legal Business Name): HILL COUNTRY DIZZINESS & BALANCE CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 BANDERA HWY SUITE 1B
KERRVILLE TX
78028-9515
US

IV. Provider business mailing address

218 QUINLAN ST SUITE 474
KERRVILLE TX
78028-5314
US

V. Phone/Fax

Practice location:
  • Phone: 830-792-2132
  • Fax: 830-792-2131
Mailing address:
  • Phone: 830-895-7675
  • Fax: 830-896-9340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberF1974
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberM6514
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberG1112
License Number StateTX

VIII. Authorized Official

Name: ANAND MEHENDALE
Title or Position: MANAGER
Credential: M.D.
Phone: 830-895-7675