MEDICARE: MUTTER'S PRECISION HEARING CENTER, 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	332S00000X	Hearing Aid Equipment	AS3398	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558590265
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUTTER'S PRECISION HEARING CENTER, INC

Provider Business Mailing Address
First Line	:	1680 SW SAINT LUCIE WEST BLVD
Second Line	:	SUITE 103
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34986-1927
Country	:	US
Telephone Number	:	772-871-1222
Fax Number	:

Provider Business Practice Location Address
First Line	:	1680 SW SAINT LUCIE WEST BLVD
Second Line	:	SUITE 103
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34986-1927
Country	:	US
Telephone Number	:	772-871-1222
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MR. JOSEPH BOYD MUTTER
Credential	:	H.A.S.
Telephone Number	:	772-871-1222

Provider Enumeration Date	:	07/02/2009
Last Update Date	:	07/02/2009

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