MEDICARE: AUDIOLOGY & HEARING CENTER OF FARMINGTON, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	2015037213	MO

General Provider Information

NPI Number	:	1184097875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUDIOLOGY & HEARING CENTER OF FARMINGTON, INC

Provider Business Mailing Address
First Line	:	620 WALTON DR
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-1935
Country	:	US
Telephone Number	:	573-756-0500
Fax Number	:

Provider Business Practice Location Address
First Line	:	620 WALTON DR
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-1935
Country	:	US
Telephone Number	:	573-756-0500
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	TAFFY COLE
Credential	:
Telephone Number	:	573-756-0500

Provider Enumeration Date	:	11/04/2015
Last Update Date	:	11/04/2015

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