Provider Demographics
NPI:1427122704
Name:JOE D CRNKOVIC DBA AUDIBLE HEARING CENTER
Entity type:Organization
Organization Name:JOE D CRNKOVIC DBA AUDIBLE HEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:D
Authorized Official - Last Name:CRNKOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:ACA
Authorized Official - Phone:979-779-3070
Mailing Address - Street 1:2305 CAVITT AVE
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77801
Mailing Address - Country:US
Mailing Address - Phone:979-779-3070
Mailing Address - Fax:979-779-7565
Practice Address - Street 1:2305 CAVITT AVE
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77801-2006
Practice Address - Country:US
Practice Address - Phone:979-779-3070
Practice Address - Fax:979-779-7565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50263237700000X
332B00000X, 332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332S00000XSuppliersHearing Aid EquipmentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX022122801Medicaid
TX516533OtherBLUE CROSS BLUE SHIELD