Provider Demographics
NPI:1538393707
Name:BROOKS HEARING CLINIC
Entity type:Organization
Organization Name:BROOKS HEARING CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMI
Authorized Official - Middle Name:H
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:AUD CCC
Authorized Official - Phone:903-737-8800
Mailing Address - Street 1:1217 S BROADWAY ST STE N
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-4888
Mailing Address - Country:US
Mailing Address - Phone:903-438-1600
Mailing Address - Fax:903-438-1627
Practice Address - Street 1:1217 S BROADWAY ST STE N
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-4888
Practice Address - Country:US
Practice Address - Phone:903-438-1600
Practice Address - Fax:903-438-1627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-04
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14561235Z00000X
TX80263237600000X
TX50734231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089238201Medicaid
TX089238202Medicaid
TX198911901Medicaid
TX089238203Medicaid
TX198911902Medicaid
TX580064Medicare PIN