Basic Information
| Provider Information | |||||||||
| NPI: | 1356691208 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARTIN AUDIOLOGY LLC | ||||||||
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| OtherOrganizationName: | MIRACLE EAR | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 203 TWISTED OAK LN | ||||||||
| Address2: | |||||||||
| City: | CRAWFORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 766382896 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2545374426 | ||||||||
| FaxNumber: | 2543004619 | ||||||||
| Practice Location | |||||||||
| Address1: | 1013 W UNIVERSITY AVE | ||||||||
| Address2: | STE. 122 | ||||||||
| City: | GEORGETOWN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786285340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5128681100 | ||||||||
| FaxNumber: | 5128681105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2012 | ||||||||
| LastUpdateDate: | 09/18/2012 | ||||||||
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| AuthorizedOfficialLastName: | KEY | ||||||||
| AuthorizedOfficialFirstName: | STEVE | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 2545374426 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | 11150 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.