MEDICARE: TONYA J ROSE H.I.S

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	629	AR

General Provider Information

NPI Number	:	1306218334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONYA J ROSE H.I.S

Provider Business Mailing Address
First Line	:	1302 N 2ND ST
Second Line	:
City	:	DARDANELLE
State	:	AR
Zip	:	72834-2850
Country	:	US
Telephone Number	:	479-280-0699
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 ROGERS AVE
Second Line	:	SUITE B
City	:	FORT SMITH
State	:	AR
Zip	:	72903-2956
Country	:	US
Telephone Number	:	479-782-7677
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2015
Last Update Date	:	10/29/2015

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