| Organization Name: | REVIVE HEARING CENTER OF SAN MARCOS, LLC |
| NPI Number: | 1528391877 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GLENN ETHE (CEO) |
| Mailing Address: | 300 Cm Allen Parkway Suite 300a San Marcos |
| State: | TX US |
| Postal Code: | 78666 |
| Phone Number: | 5126676904 |
| Fax Number: | 5126677138 |
| NPI Enumeration Date: | 09/17/2009 |
| NPI Last Update Date: | 10/23/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332S00000X |
| License Number: | 32039416220 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Hearing Aid Equipment |
| Taxonomy Specialization: | |
| Taxonomy Definition: | The manufacture and/or sale of electronic hearing aids, their component parts, and related products and services on a national basis. |