Healthcare Provider Details

I. General information

NPI: 1164051934
Provider Name (Legal Business Name): SCOTT OBERMILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 04/03/2020
Certification Date: 04/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4802 DIXIE HWY
LOUISVILLE KY
40216-2504
US

IV. Provider business mailing address

2888 ELMBURG RD
SHELBYVILLE KY
40065-7925
US

V. Phone/Fax

Practice location:
  • Phone: 502-447-2828
  • Fax:
Mailing address:
  • Phone: 812-216-8248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number251354
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: