MEDICARE: DR. RUSSELL THOMAS TERRILL AU.D,

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	AU2015	CA
2	231H00000X	Audiologist	AU2015	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366468118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL THOMAS TERRILL AU.D,

Provider Business Mailing Address
First Line	:	4677 VALLEY EAST BLVD
Second Line	:	SUITE 2
City	:	ARCATA
State	:	CA
Zip	:	95521-4630
Country	:	US
Telephone Number	:	707-822-9122
Fax Number	:

Provider Business Practice Location Address
First Line	:	4677 VALLEY EAST BLVD
Second Line	:	SUITE 2
City	:	ARCATA
State	:	CA
Zip	:	95521-4630
Country	:	US
Telephone Number	:	707-822-9122
Fax Number	:

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	03/23/2011

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