MEDICARE: PEB ENTERPRISES 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	237600000X	Audiologist-Hearing Aid Fitter	51506	TX
2	237700000X	Hearing Instrument Specialist	50602	TX
3	237700000X	Hearing Instrument Specialist	20246	TX

General Provider Information

NPI Number	:	1619201589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEB ENTERPRISES INC.

Provider Business Mailing Address
First Line	:	3600 FM 2181 STE 300
Second Line	:
City	:	HICKORY CREEK
State	:	TX
Zip	:	75065-7636
Country	:	US
Telephone Number	:	940-321-1311
Fax Number	:	940-497-1374

Provider Business Practice Location Address
First Line	:	6353 CAMP BOWIE BLVD STE 113
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-5461
Country	:	US
Telephone Number	:	817-763-0863
Fax Number	:	817-731-3692

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PETER R BERRY
Credential	:	H.I.S.
Telephone Number	:	940-321-1311

Provider Enumeration Date	:	09/25/2009
Last Update Date	:	09/28/2011

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