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General NPI Number Information
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NPI Number | 1629262480
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Entity Type | Organization
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Legal Business Name | MICRO HEARING AID CENTER
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Dates
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Enumeration Date | 09/04/2007
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Last Update Date | 09/04/2007
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Provider Practice Location Address
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Address Line | 6500 NEWCASTLE ST
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City | BELLAIRE
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State | TX
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Zip | 77401-4314
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Country | US
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Telephone | 713-666-9880
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Fax | 713-664-7035
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Provider Business Mailing Address
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Address Line | 6500 NEWCASTLE ST
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City | BELLAIRE
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State | TX
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Zip | 77401-4314
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Country | US
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Telephone | 713-666-9880
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Fax | 713-664-7035
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Authorized Official
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Title or Position | OWNER
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Name | MR. JERRY D. ILLING
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Credential | BC-HIS
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Telephone | 713-666-9880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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License Number | 50293
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License Number State | TX
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