MEDICARE: JILLIAN L MORENO HIS

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	237700000X	Hearing Instrument Specialist	3343	IL

General Provider Information

NPI Number	:	1285266213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILLIAN L MORENO HIS

Provider Business Mailing Address
First Line	:	1415 W HIGHWAY 50
Second Line	:
City	:	O FALLON
State	:	IL
Zip	:	62269-1618
Country	:	US
Telephone Number	:	618-624-4471
Fax Number	:	618-624-4496

Provider Business Practice Location Address
First Line	:	3142 NAMEOKI RD
Second Line	:
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-5013
Country	:	US
Telephone Number	:	618-451-1900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2020
Last Update Date	:	02/07/2020

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Directions to “ JILLIAN L MORENO HIS” Practice Location

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