MEDICARE: CAMAS HEARING CLINIC

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	231H00000X	Audiologist	LD00001396	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ABO3651	OTHER	WA	MEDICARE IDTYPE UNSPECIFIED

General Provider Information

NPI Number	:	1386900132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMAS HEARING CLINIC

Provider Business Mailing Address
First Line	:	605 NE 5TH AVE
Second Line	:
City	:	CAMAS
State	:	WA
Zip	:	98607-2007
Country	:	US
Telephone Number	:	360-833-0609
Fax Number	:	360-833-0622

Provider Business Practice Location Address
First Line	:	605 NE 5TH AVE
Second Line	:
City	:	CAMAS
State	:	WA
Zip	:	98607-2007
Country	:	US
Telephone Number	:	360-833-0609
Fax Number	:	360-833-0622

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOSEPH J RAAP
Credential	:	AU D
Telephone Number	:	360-833-0609

Provider Enumeration Date	:	04/05/2012
Last Update Date	:	04/05/2012

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Directions to “CAMAS HEARING CLINIC ” Practice Location

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