Basic Information
Provider Information | |||||||||
NPI: | 1295368470 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | J.L. MIGUEZ, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | NEWSOUND HEARING CENTERS | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2230 W. GRANDE BLVD., SUITE 100 | ||||||||
Address2: |   | ||||||||
City: | TYLER | ||||||||
State: | TX | ||||||||
PostalCode: | 75703 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9035619992 | ||||||||
FaxNumber: | 9035619277 | ||||||||
Practice Location | |||||||||
Address1: | 125 W. BROAD STREET | ||||||||
Address2: |   | ||||||||
City: | MINEOLA | ||||||||
State: | TX | ||||||||
PostalCode: | 75773 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9036388524 | ||||||||
FaxNumber: | 9036388526 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/17/2020 | ||||||||
LastUpdateDate: | 02/20/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MIGUEZ | ||||||||
AuthorizedOfficialFirstName: | JOHN | ||||||||
AuthorizedOfficialMiddleName: | L. | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 9035619992 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | J. L. MIGUEZ, INC., DBA NEWSOUND HEARING CE | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | H.I.S. | ||||||||
NPICertificationDate: | 02/20/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332S00000X |   |   | Y |   | Suppliers | Hearing Aid Equipment |   |
No ID Information.