=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861829988
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEAR WELL HEARING CARE CENTRE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2013
-----------------------------------------------------
Last Update Date | 10/03/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1221 W SPRESSER ST
-----------------------------------------------------
City | TAYLORVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62568-1714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-824-5210
-----------------------------------------------------
Fax | 217-824-5211
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1221 W SPRESSER ST
-----------------------------------------------------
City | TAYLORVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62568
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-824-5210
-----------------------------------------------------
Fax | 217-824-5211
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HEARING AIDE SPECIALIST
-----------------------------------------------------
Name | DONALD DENNIS BETTIS
-----------------------------------------------------
Credential | BC-HIS
-----------------------------------------------------
Telephone | 217-824-5210
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332S00000X
-----------------------------------------------------
Taxonomy Name | Hearing Aid Equipment
-----------------------------------------------------
License Number | 1966
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------