MEDICARE: JASON COOPER HCP

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	17001200A	IN
2	237700000X	Hearing Instrument Specialist	17001200A	IN

General Provider Information

NPI Number	:	1558039925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON COOPER HCP

Provider Business Mailing Address
First Line	:	2680 E MAIN ST STE 307
Second Line	:
City	:	PLAINFIELD
State	:	IN
Zip	:	46168-2949
Country	:	US
Telephone Number	:	317-409-3681
Fax Number	:

Provider Business Practice Location Address
First Line	:	2680 E MAIN ST STE 307
Second Line	:
City	:	PLAINFIELD
State	:	IN
Zip	:	46168-2949
Country	:	US
Telephone Number	:	317-409-3681
Fax Number	:

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

Provider Enumeration Date	:	09/01/2021
Last Update Date	:	09/01/2021

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Directions to “ JASON COOPER HCP” Practice Location

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