MEDICARE: FONNER HEARING AID CENTER

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
1	261QH0700X	Hearing and Speech Clinic/Center	50312	TX

General Provider Information

NPI Number	:	1346447505
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FONNER HEARING AID CENTER

Provider Business Mailing Address
First Line	:	6647 BOULEVARD 26
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76180-1570
Country	:	US
Telephone Number	:	817-284-8584
Fax Number	:	817-284-3253

Provider Business Practice Location Address
First Line	:	6647 BOULEVARD 26
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76180-1570
Country	:	US
Telephone Number	:	817-284-8584
Fax Number	:	817-284-3253

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CARL W. FONNER
Credential	:	B.C., NBC-HIS, A.C.A
Telephone Number	:	817-284-8584

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	08/22/2020

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