MEDICARE: PROFESSIONAL HEARING CENTER, 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	2004021609	MO

General Provider Information

NPI Number	:	1205094257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL HEARING CENTER, INC

Provider Business Mailing Address
First Line	:	112 CONGRESS ST
Second Line	:
City	:	BELTON
State	:	MO
Zip	:	64012-2400
Country	:	US
Telephone Number	:	816-331-4327
Fax Number	:	816-331-4344

Provider Business Practice Location Address
First Line	:	112 CONGRESS ST
Second Line	:
City	:	BELTON
State	:	MO
Zip	:	64012-2400
Country	:	US
Telephone Number	:	816-331-4327
Fax Number	:	816-331-4344

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. KELLY N SPILLER
Credential	:	AU.D.
Telephone Number	:	816-331-4327

Provider Enumeration Date	:	05/27/2008
Last Update Date	:	05/27/2008

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