MEDICARE: JACK JONES HEARING CENTERS, INC.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	231H00000X	Audiologist
2	237600000X	Audiologist-Hearing Aid Fitter
3	237700000X	Hearing Instrument Specialist
4	332S00000X	Hearing Aid Equipment

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0615164	OTHER	TX	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	530294	OTHER	TX	BCBS

NPI Number	:	1134115256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACK JONES HEARING CENTERS, INC.

Provider Business Mailing Address
First Line	:	750 N COMMONS DR STE 200
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-8025
Country	:	US
Telephone Number	:	630-303-5380
Fax Number	:	630-303-5385

Provider Business Practice Location Address
First Line	:	400 S HENDERSON ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-1017
Country	:	US
Telephone Number	:	817-335-2583
Fax Number	:	817-335-2597

Authorized Official
Title or Position	:	VP, FINANCE AND CONTROLLING
Name	:	VICKI COLE
Credential	:
Telephone Number	:	331-305-8086

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	07/22/2025

412 S HENDERSON ST
FORT WORTH, TX
76104-1017

Practice Phone: 817-335-2606
Practice Fax: 817-335-2635