MEDICARE: ADVANCED HEARING, INC

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	HAS153	NV

General Provider Information

NPI Number	:	1508090168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED HEARING, INC

Provider Business Mailing Address
First Line	:	2360 MENDOCINO AVE # A2-106
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-3153
Country	:	US
Telephone Number	:	707-291-2448
Fax Number	:

Provider Business Practice Location Address
First Line	:	3850 E SUNSET RD STE F
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-4913
Country	:	US
Telephone Number	:	702-873-1589
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MIKE OWEN
Credential	:	AA
Telephone Number	:	707-291-2448

Provider Enumeration Date	:	05/12/2009
Last Update Date	:	05/12/2009

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