MEDICARE: MR. TODD CARL ALLEN 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	838	TN

General Provider Information

NPI Number	:	1962950014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TODD CARL ALLEN HIS

Provider Business Mailing Address
First Line	:	212 S PETERS RD
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-5238
Country	:	US
Telephone Number	:	276-200-8463
Fax Number	:

Provider Business Practice Location Address
First Line	:	212 S PETERS RD
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-5238
Country	:	US
Telephone Number	:	276-200-8463
Fax Number	:

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

Provider Enumeration Date	:	09/19/2016
Last Update Date	:	09/19/2016

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