MEDICARE: MR. WILLIAM JONES

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	2741	IL

General Provider Information

NPI Number	:	1629159124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM JONES

Provider Business Mailing Address
First Line	:	106 SCRANTON AVE
Second Line	:
City	:	PITTSBURG
State	:	IL
Zip	:	62974
Country	:	US
Telephone Number	:	618-993-1406
Fax Number	:	618-993-5519

Provider Business Practice Location Address
First Line	:	2300 W MAIN ST
Second Line	:
City	:	MARION
State	:	IL
Zip	:	62959-1179
Country	:	US
Telephone Number	:	618-993-1406
Fax Number	:	618-993-5519

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/08/2007

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