MEDICARE: EARCARE OF GREAT BEND, 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	CE596	KS

General Provider Information

NPI Number	:	1962632455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EARCARE OF GREAT BEND, INC.

Provider Business Mailing Address
First Line	:	1925 MAIN ST
Second Line	:
City	:	GREAT BEND
State	:	KS
Zip	:	67530-2549
Country	:	US
Telephone Number	:	620-603-6445
Fax Number	:	620-603-6525

Provider Business Practice Location Address
First Line	:	1925 MAIN ST
Second Line	:
City	:	GREAT BEND
State	:	KS
Zip	:	67530-2549
Country	:	US
Telephone Number	:	620-603-6445
Fax Number	:	620-603-6525

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MR. TIM BRECHEISEN
Credential	:
Telephone Number	:	316-269-4327

Provider Enumeration Date	:	07/20/2009
Last Update Date	:	07/20/2009

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