MEDICARE: CENTERVILLE HEARING CENTER, LLC

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	261QH0700X	Hearing and Speech Clinic/Center	03304	OH

General Provider Information

NPI Number	:	1558805614
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTERVILLE HEARING CENTER, LLC

Provider Business Mailing Address
First Line	:	7081 CORPORATE WAY
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-4223
Country	:	US
Telephone Number	:	937-476-7186
Fax Number	:

Provider Business Practice Location Address
First Line	:	7081 CORPORATE WAY
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-4223
Country	:	US
Telephone Number	:	937-476-7186
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	LINDSAY R ANDERSON
Credential	:
Telephone Number	:	937-545-9740

Provider Enumeration Date	:	12/08/2016
Last Update Date	:	12/08/2016

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