=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982904926
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LONESTAR HEARING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2010
-----------------------------------------------------
Last Update Date | 10/25/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 EXECUTIVE CT SUITE 100B
-----------------------------------------------------
City | WAXAHACHIE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75165-1970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-351-9136
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 EXECUTIVE CT SUITE 100B
-----------------------------------------------------
City | WAXAHACHIE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75165-1970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-351-9136
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | MR. WILLIAM MICHAEL GLEASON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 972-351-9136
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | 80379
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------