=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588038657
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPLETE HEARING CENTERS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2015
-----------------------------------------------------
Last Update Date | 11/30/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 745 W SAN ANTONIO AVE
-----------------------------------------------------
City | BOERNE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78006-3213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-616-0283
-----------------------------------------------------
Fax | 210-918-6973
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4775 HAMILTON WOLFE RD STE 1
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78229-3456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-616-0283
-----------------------------------------------------
Fax | 210-918-6973
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. PAUL TREVINO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 210-616-0283
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------