MEDICARE: AUDIOLOGY & HEARING CENTER OF FARMINGTON, 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	237600000X	Audiologist-Hearing Aid Fitter	113484	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45-00144	OTHER	MO	UHC
2	193973	OTHER	MO	BCBS
3	7035519	OTHER	MO	AETNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	621859	OTHER	MO	HEALTHLINK

General Provider Information

NPI Number	:	1124060561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUDIOLOGY & HEARING CENTER OF FARMINGTON, INC

Provider Business Mailing Address
First Line	:	620 WALTON DR
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-1935
Country	:	US
Telephone Number	:	573-756-0500
Fax Number	:	573-756-0505

Provider Business Practice Location Address
First Line	:	620 WALTON DR
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-1935
Country	:	US
Telephone Number	:	573-756-0500
Fax Number	:	573-756-0505

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KAREN RENEE MELTON
Credential	:	AU.D.
Telephone Number	:	573-756-0500

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	08/17/2018

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