MEDICARE: MCCRAE MANAGEMENT

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

General Provider Information

NPI Number	:	1497153548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCCRAE MANAGEMENT

Provider Business Mailing Address
First Line	:	26222 RANCH ROAD 12
Second Line	:
City	:	DRIPPING SPRINGS
State	:	TX
Zip	:	78620-4903
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10395 NW GLENCOE RD
Second Line	:	SUITE 500
City	:	NORTH PLAINS
State	:	OR
Zip	:	97133-8208
Country	:	US
Telephone Number	:	503-647-2095
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	KIM JOHNSON
Credential	:
Telephone Number	:	512-858-0300

Provider Enumeration Date	:	12/05/2014
Last Update Date	:	12/05/2014

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