MEDICARE: MR. JAY HILTON THURMAN BC-HIS

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	HAS-P-756055	OR

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

General Provider Information

NPI Number	:	1700119757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAY HILTON THURMAN BC-HIS

Provider Business Mailing Address
First Line	:	4311 NE TILLAMOOK STREET
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97213-1315
Country	:	US
Telephone Number	:	503-774-3668
Fax Number	:	503-774-7247

Provider Business Practice Location Address
First Line	:	4311 NE TILLAMOOK STREET
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97213-1315
Country	:	US
Telephone Number	:	503-774-3668
Fax Number	:	503-774-7247

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

Provider Enumeration Date	:	09/09/2009
Last Update Date	:	09/09/2009

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