MEDICARE: MOHAVE HEARING 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	332S00000X	Hearing Aid Equipment	20096400-N	AZ

General Provider Information

NPI Number	:	1275579351
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOHAVE HEARING LLC

Provider Business Mailing Address
First Line	:	5221 S HWY 95
Second Line	:	SUITE 12
City	:	FT MOHAVE
State	:	AZ
Zip	:	86426-9244
Country	:	US
Telephone Number	:	928-768-9020
Fax Number	:	928-768-9030

Provider Business Practice Location Address
First Line	:	5221 S HWY 95
Second Line	:	SUITE 12
City	:	FT MOHAVE
State	:	AZ
Zip	:	86426-9244
Country	:	US
Telephone Number	:	928-768-9020
Fax Number	:	928-768-9030

Authorized Official
Title or Position	:	OWNER
Name	:	JANET A DEVORE
Credential	:
Telephone Number	:	928-768-9020

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	08/22/2020

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