Basic Information
| Provider Information | |||||||||
| NPI: | 1821435538 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | METX LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MIRACLE EAR CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 204 WOODHEW DR | ||||||||
| Address2: | |||||||||
| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767126529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2548700574 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4618 SW LOOP 820 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177639993 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2013 | ||||||||
| LastUpdateDate: | 07/11/2018 | ||||||||
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| AuthorizedOfficialLastName: | BRAUS | ||||||||
| AuthorizedOfficialFirstName: | SABRINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMIN | ||||||||
| AuthorizedOfficialTelephone: | 2548700574 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 80271 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.