MEDICARE: LIFETIME HEARING CLINIC, 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	174400000X	Specialist	1291	TN

General Provider Information

NPI Number	:	1548588650
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFETIME HEARING CLINIC, INC.

Provider Business Mailing Address
First Line	:	1430 W BADDOUR PKWY
Second Line	:	SUITE D
City	:	LEBANON
State	:	TN
Zip	:	37087-2656
Country	:	US
Telephone Number	:	615-443-4070
Fax Number	:	615-443-4432

Provider Business Practice Location Address
First Line	:	1430 W BADDOUR PKWY
Second Line	:	SUITE D
City	:	LEBANON
State	:	TN
Zip	:	37087-2656
Country	:	US
Telephone Number	:	615-443-4070
Fax Number	:	615-443-4432

Authorized Official
Title or Position	:	AUDIOLOGIST/OWNER
Name	:	DR. HEATHER L DOOLEY
Credential	:	AU.D., CCC-A
Telephone Number	:	615-443-4070

Provider Enumeration Date	:	05/13/2010
Last Update Date	:	05/13/2010

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