MEDICARE: LORI HUNTER 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	0674	SC

General Provider Information

NPI Number	:	1841808359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI HUNTER HIS

Provider Business Mailing Address
First Line	:	318 CAROLA LN
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-3941
Country	:	US
Telephone Number	:	803-543-2782
Fax Number	:

Provider Business Practice Location Address
First Line	:	2921 AUGUSTA RD STE B
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29170-3319
Country	:	US
Telephone Number	:	803-543-2782
Fax Number	:

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

Provider Enumeration Date	:	07/21/2020
Last Update Date	:	07/21/2020

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