MEDICARE: THE HEARING CLINIC

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	231H00000X	Audiologist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C09445	OTHER	VA	MEDICARE GROUP NUMBER

General Provider Information

NPI Number	:	1023116795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE HEARING CLINIC

Provider Business Mailing Address
First Line	:	PO BOX 886
Second Line	:
City	:	BLACKSBURG
State	:	VA
Zip	:	24063-0886
Country	:	US
Telephone Number	:	540-953-2916
Fax Number	:	540-951-0302

Provider Business Practice Location Address
First Line	:	820 UNIVERSITY CITY BLVD
Second Line	:
City	:	BLACKSBURG
State	:	VA
Zip	:	24060-2708
Country	:	US
Telephone Number	:	540-552-1904
Fax Number	:	540-951-0302

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MR. JOHN F MANGELS
Credential	:
Telephone Number	:	540-953-2916

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	05/30/2008

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Directions to “THE HEARING CLINIC ” Practice Location

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