=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992096077
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MD HEARING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2011
-----------------------------------------------------
Last Update Date | 02/27/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5347 MAIN STREET 102
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34652-2506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-807-7082
-----------------------------------------------------
Fax | 727-807-7083
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5347 MAIN ST 102
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34652-2506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-807-7082
-----------------------------------------------------
Fax | 727-807-7083
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | DANA SCHWANEMANN
-----------------------------------------------------
Credential | HAS
-----------------------------------------------------
Telephone | 727-807-7082
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | AS3911
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------