=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194027722
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREMIER AUDIOLOGY AND HEARING AID CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2010
-----------------------------------------------------
Last Update Date | 12/02/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6624 FANNIN ST SUITE 1480
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-2312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-790-1272
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6624 FANNIN ST SUITE 1482
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-2312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-790-1272
-----------------------------------------------------
Fax | 713-512-8383
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE OWNER
-----------------------------------------------------
Name | DR. SAMUEL C WEBER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 713-790-1272
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237600000X
-----------------------------------------------------
Taxonomy Name | Audiologist-Hearing Aid Fitter
-----------------------------------------------------
License Number | 50477
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------