=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487973640
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHILLIPS HEARING CENTER INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2010
-----------------------------------------------------
Last Update Date | 05/26/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 103 C. MICHAEL DAVENPORT BLVD. STE. 2
-----------------------------------------------------
City | FRANKFORT
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-352-2468
-----------------------------------------------------
Fax | 502-352-2472
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 103 C. MICHAEL DAVENPORT BLVD. STE. 2
-----------------------------------------------------
City | FRANKFORT
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-352-2468
-----------------------------------------------------
Fax | 502-352-2472
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HEARING INSTRUMENT SPECIALIST
-----------------------------------------------------
Name | MR. RUSSELL GLENN PHILLIPS
-----------------------------------------------------
Credential | H.I.S.
-----------------------------------------------------
Telephone | 502-352-2468
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332S00000X
-----------------------------------------------------
Taxonomy Name | Hearing Aid Equipment
-----------------------------------------------------
License Number | KY0955
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------