Provider Demographics
NPI:1154421337
Name:PROFESSIONAL HEARING CENTERS
Entity type:Organization
Organization Name:PROFESSIONAL HEARING CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER HEARING AID DISPENSER
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:HEARING AID DESPENSE
Authorized Official - Phone:903-757-3900
Mailing Address - Street 1:1511 JUDSON RD
Mailing Address - Street 2:STE A
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601
Mailing Address - Country:US
Mailing Address - Phone:903-757-3900
Mailing Address - Fax:903-236-3108
Practice Address - Street 1:1511 JUDSON RD
Practice Address - Street 2:STE A
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601
Practice Address - Country:US
Practice Address - Phone:903-757-3900
Practice Address - Fax:903-236-3108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50671237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty