MEDICARE: ALLEN HEARING CLINIC, INC.

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	261QH0700X	Hearing and Speech Clinic/Center

General Provider Information

NPI Number	:	1063778421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLEN HEARING CLINIC, INC.

Provider Business Mailing Address
First Line	:	423 E MAIN ST STE 1
Second Line	:
City	:	MIDLOTHIAN
State	:	TX
Zip	:	76065-3345
Country	:	US
Telephone Number	:	972-723-6181
Fax Number	:

Provider Business Practice Location Address
First Line	:	423 E MAIN ST STE 1
Second Line	:
City	:	MIDLOTHIAN
State	:	TX
Zip	:	76065-3345
Country	:	US
Telephone Number	:	972-723-6181
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHELE GILLENTINE
Credential	:
Telephone Number	:	972-747-1333

Provider Enumeration Date	:	04/10/2012
Last Update Date	:	04/10/2012

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