MEDICARE: PROGRESSIVE HEARING & BALANCE 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	231H00000X	Audiologist	AY740	FL

General Provider Information

NPI Number	:	1568634673
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE HEARING & BALANCE CENTER, INC.

Provider Business Mailing Address
First Line	:	1100 KANE CONCOURSE
Second Line	:
City	:	BAY HARBOR ISLANDS
State	:	FL
Zip	:	33154-2013
Country	:	US
Telephone Number	:	305-864-7110
Fax Number	:	305-864-7114

Provider Business Practice Location Address
First Line	:	1100 KANE CONCOURSE
Second Line	:
City	:	BAY HARBOR ISLANDS
State	:	FL
Zip	:	33154-2013
Country	:	US
Telephone Number	:	305-864-7110
Fax Number	:	305-864-7114

Authorized Official
Title or Position	:	OWNER/AUDIOLOGIST
Name	:	DR. SUSAN RAE ROTH
Credential	:	PH.D
Telephone Number	:	305-864-7110

Provider Enumeration Date	:	03/28/2008
Last Update Date	:	03/28/2008

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