MEDICARE: MOBILE AUDIOLOGY & HEARING AIDS LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AY2158	OTHER	FL	FLORIDA AUDIOLOGY LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134758550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILE AUDIOLOGY & HEARING AIDS LLC

Provider Business Mailing Address
First Line	:	8550 TOUCHTON RD APT 2236
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-2237
Country	:	US
Telephone Number	:	904-445-1622
Fax Number	:	904-293-1815

Provider Business Practice Location Address
First Line	:	905 BEACH BLVD STE B
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-4303
Country	:	US
Telephone Number	:	904-445-1622
Fax Number	:	904-293-1815

Authorized Official
Title or Position	:	AUDIOLOGIST/OWNER
Name	:	KIMBERLY HELEN DESMOND
Credential	:	AUDIOLOGIST MS
Telephone Number	:	904-445-1622

Provider Enumeration Date	:	04/07/2020
Last Update Date	:	07/03/2020

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