Provider Demographics
NPI: | 1215320601 |
---|---|
Name: | ADVANCED AUDIOLOGY CENTER |
Entity type: | Organization |
Organization Name: | ADVANCED AUDIOLOGY CENTER |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER/AUDIOLOGIST |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LAURA |
Authorized Official - Middle Name: | ANN |
Authorized Official - Last Name: | TRAINOR-COLLINS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MS, CCC/A |
Authorized Official - Phone: | 972-494-6537 |
Mailing Address - Street 1: | 2318 W WALNUT ST STE B |
Mailing Address - Street 2: | |
Mailing Address - City: | GARLAND |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75042-6621 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 972-494-6537 |
Mailing Address - Fax: | 972-494-5461 |
Practice Address - Street 1: | 2318 W WALNUT ST STE B |
Practice Address - Street 2: | |
Practice Address - City: | GARLAND |
Practice Address - State: | TX |
Practice Address - Zip Code: | 75042-6621 |
Practice Address - Country: | US |
Practice Address - Phone: | 972-494-6537 |
Practice Address - Fax: | 972-494-5461 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-03-10 |
Last Update Date: | 2015-03-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 50778 | 332S00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332S00000X | Suppliers | Hearing Aid Equipment |