Healthcare Provider Details

I. General information

NPI: 1962687723
Provider Name (Legal Business Name): WTHAC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 10/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2508 N GRANDVIEW AVE
ODESSA TX
79761-1606
US

IV. Provider business mailing address

1387 BAT MASTERSON DR
EL PASO TX
79936-7850
US

V. Phone/Fax

Practice location:
  • Phone: 432-368-7777
  • Fax: 432-363-4327
Mailing address:
  • Phone: 915-860-1593
  • Fax: 915-860-1593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: LAURA F CARPENTER
Title or Position: PRESIDENT
Credential:
Phone: 915-860-1593