MEDICARE: PROFESSIONAL HEARING SOLUTIONS

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	237600000X	Audiologist-Hearing Aid Fitter

General Provider Information

NPI Number	:	1326622440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL HEARING SOLUTIONS

Provider Business Mailing Address
First Line	:	375 DEER RUN
Second Line	:
City	:	SUMERCO
State	:	WV
Zip	:	25567-9541
Country	:	US
Telephone Number	:	304-784-2552
Fax Number	:	304-756-3818

Provider Business Practice Location Address
First Line	:	2150 CHILDRESS RD
Second Line	:
City	:	ALUM CREEK
State	:	WV
Zip	:	25003-9546
Country	:	US
Telephone Number	:	304-784-2552
Fax Number	:	304-756-3818

Authorized Official
Title or Position	:	OWNER/AUDIOLOGIST
Name	:	DR. NANCY BETH GILLISPIE
Credential	:	AUD
Telephone Number	:	304-784-2552

Provider Enumeration Date	:	05/06/2021
Last Update Date	:	05/06/2021

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