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NPI Code Detail

MEDICARE: FW HEARING LLC

MEDICARE: FW HEARING LLC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1261QH0700XHearing and Speech Clinic/Center50913TX

General Provider Information

NPI Number : 1134592744
Entity Type Code : Organization
Provider Name (Legal Business Name) : FW HEARING LLC
Provider Business Mailing Address
First Line : 4823 CAMP BOWIE BLVD
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-4150
Country : US
Telephone Number : 817-439-9205
Fax Number :
Provider Business Practice Location Address
First Line : 4823 CAMP BOWIE BLVD
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-4150
Country : US
Telephone Number : 817-439-9205
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MARC BOTIK
Credential :
Telephone Number : 817-439-9205
Provider Enumeration Date : 11/04/2015
Last Update Date : 11/04/2015

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Directions to “FW HEARING LLC ” Practice Location

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