MEDICARE: EARS OF ARDMORE, 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	332S00000X	Hearing Aid Equipment	316	OK

General Provider Information

NPI Number	:	1891972394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EARS OF ARDMORE, INC

Provider Business Mailing Address
First Line	:	1505 N COMMERCE ST STE 111
Second Line	:
City	:	ARDMORE
State	:	OK
Zip	:	73401-1859
Country	:	US
Telephone Number	:	580-224-0377
Fax Number	:	580-226-2237

Provider Business Practice Location Address
First Line	:	1505 N COMMERCE ST STE 111
Second Line	:
City	:	ARDMORE
State	:	OK
Zip	:	73401-1859
Country	:	US
Telephone Number	:	580-224-0377
Fax Number	:	580-226-2237

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JENI A MERRICK
Credential	:	AU., D
Telephone Number	:	580-224-0377

Provider Enumeration Date	:	01/28/2008
Last Update Date	:	01/28/2008

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Directions to “EARS OF ARDMORE, INC ” Practice Location

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