MEDICARE: PROFESSIONAL AUDIOLOGY AND 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	42	NE

General Provider Information

NPI Number	:	1215393228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL AUDIOLOGY AND HEARING CENTER, INC

Provider Business Mailing Address
First Line	:	4509 LEAVENWORTH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68106-1418
Country	:	US
Telephone Number	:	402-558-0440
Fax Number	:	402-558-7794

Provider Business Practice Location Address
First Line	:	4509 LEAVENWORTH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68106-1418
Country	:	US
Telephone Number	:	402-558-0440
Fax Number	:	402-558-7794

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROGER LOUIS MCGARGILL
Credential	:	PH.D.
Telephone Number	:	402-558-0440

Provider Enumeration Date	:	01/06/2016
Last Update Date	:	01/06/2016

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