MEDICARE: STANLEY HEARING & AUDIOLOGY

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	237700000X	Hearing Instrument Specialist	2008020655	MO

General Provider Information

NPI Number	:	1023361458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STANLEY HEARING & AUDIOLOGY

Provider Business Mailing Address
First Line	:	223 N 65TH ST
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66102-3024
Country	:	US
Telephone Number	:	816-308-6873
Fax Number	:

Provider Business Practice Location Address
First Line	:	27 NW BARRY RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-2728
Country	:	US
Telephone Number	:	816-455-1588
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SHAWN PATRICK STANLEY
Credential	:	BC-HIS
Telephone Number	:	816-308-6873

Provider Enumeration Date	:	10/23/2012
Last Update Date	:	10/23/2012

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