MEDICARE: NORTHEAST TEXAS HEARING SERVICES

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	231H00000X	Audiologist	51120	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508811365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST TEXAS HEARING SERVICES

Provider Business Mailing Address
First Line	:	1001 E AUSTIN ST
Second Line	:
City	:	PARIS
State	:	TX
Zip	:	75460-7483
Country	:	US
Telephone Number	:	903-785-5800
Fax Number	:	903-785-5821

Provider Business Practice Location Address
First Line	:	1001 E AUSTIN ST
Second Line	:
City	:	PARIS
State	:	TX
Zip	:	75460-7483
Country	:	US
Telephone Number	:	903-785-5800
Fax Number	:	903-785-5821

Authorized Official
Title or Position	:	OWNER
Name	:	FANNIE M TURNER
Credential	:	MS, CCC-A
Telephone Number	:	903-785-5800

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	06/22/2010

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Directions to “NORTHEAST TEXAS HEARING SERVICES ” Practice Location

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