MEDICARE: HEARING CARE CENTERS, SW WA 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		WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578564126
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARING CARE CENTERS, SW WA INC.

Provider Business Mailing Address
First Line	:	407 S TOWER AVE
Second Line	:
City	:	CENTRALIA
State	:	WA
Zip	:	98531-3917
Country	:	US
Telephone Number	:	360-736-6283
Fax Number	:	360-736-2606

Provider Business Practice Location Address
First Line	:	407 S TOWER AVE
Second Line	:
City	:	CENTRALIA
State	:	WA
Zip	:	98531-3917
Country	:	US
Telephone Number	:	360-736-6283
Fax Number	:	360-736-2606

Authorized Official
Title or Position	:	REGIONAL MANAGER
Name	:	MR. JON E. PANNETTE
Credential	:
Telephone Number	:	360-736-6283

Provider Enumeration Date	:	08/04/2005
Last Update Date	:	08/22/2020

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