MEDICARE: MIDWEST 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	332S00000X	Hearing Aid Equipment	108339	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1821038324	OTHER	MO	NPI

General Provider Information

NPI Number	:	1568839207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST HEARING CENTER, LLC

Provider Business Mailing Address
First Line	:	11627 GRAVOIS RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63126-3013
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11627 GRAVOIS RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63126-3013
Country	:	US
Telephone Number	:	314-729-1326
Fax Number	:

Authorized Official
Title or Position	:	OWNER/AUDIOLOGIST
Name	:	PAMELA MOSHER
Credential	:	M.S., CCC-A
Telephone Number	:	314-729-1326

Provider Enumeration Date	:	08/28/2015
Last Update Date	:	08/28/2015

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