MEDICARE: ROBERT C HIGH BC-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	3254	IL

General Provider Information

NPI Number	:	1487059044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT C HIGH BC-HIS

Provider Business Mailing Address
First Line	:	620 N LOGAN AVE
Second Line	:
City	:	DANVILLE
State	:	IL
Zip	:	61832-4362
Country	:	US
Telephone Number	:	217-442-1900
Fax Number	:	217-442-1765

Provider Business Practice Location Address
First Line	:	1302 CHARLESTON AVE
Second Line	:
City	:	MATTOON
State	:	IL
Zip	:	61938-4016
Country	:	US
Telephone Number	:	217-235-5203
Fax Number	:	217-235-5210

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

Provider Enumeration Date	:	10/24/2014
Last Update Date	:	04/08/2020

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