MEDICARE: DESTIN HEARING SPECIALISTS, 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	L05000122403	FL

General Provider Information

NPI Number	:	1356601967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESTIN HEARING SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	50 S HOLIDAY RD
Second Line	:	SUITE 400
City	:	MIRAMAR BEACH
State	:	FL
Zip	:	32550-8606
Country	:	US
Telephone Number	:	850-654-3373
Fax Number	:	850-654-3369

Provider Business Practice Location Address
First Line	:	50 S HOLIDAY RD
Second Line	:	SUITE 400
City	:	MIRAMAR BEACH
State	:	FL
Zip	:	32550-8606
Country	:	US
Telephone Number	:	850-654-3373
Fax Number	:	850-654-3369

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SEAN M. MCWILLIAMS
Credential	:	M.D.
Telephone Number	:	850-654-3373

Provider Enumeration Date	:	05/17/2012
Last Update Date	:	05/17/2012

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