Healthcare Provider Details

I. General information

NPI: 1063339810
Provider Name (Legal Business Name): TROY BIRMINGHAM HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 4TH ST
LONGVIEW TX
75605-7954
US

IV. Provider business mailing address

510B E LOOP 281 # 701
LONGVIEW TX
75605-5000
US

V. Phone/Fax

Practice location:
  • Phone: 903-475-0028
  • Fax:
Mailing address:
  • Phone: 318-834-4827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number80914
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: