MEDICARE: MARK JOHNSTON HID

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	2657	MN

General Provider Information

NPI Number	:	1588055024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK JOHNSTON HID

Provider Business Mailing Address
First Line	:	2700 N BROADWAY
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55906-3980
Country	:	US
Telephone Number	:	507-281-8989
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 N BROADWAY
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55906-3980
Country	:	US
Telephone Number	:	507-281-8989
Fax Number	:

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

Provider Enumeration Date	:	02/05/2015
Last Update Date	:	02/05/2015

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