MEDICARE: SOUTHERN MISSOURI HEARING SPECIALISTS, LLC

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

General Provider Information

NPI Number	:	1568764199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN MISSOURI HEARING SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	3100 INDEPENDENCE SQ
Second Line	:	SUITE 2
City	:	WEST PLAINS
State	:	MO
Zip	:	65775-4235
Country	:	US
Telephone Number	:	417-255-1374
Fax Number	:	417-256-5040

Provider Business Practice Location Address
First Line	:	3100 INDEPENDENCE SQ
Second Line	:	SUITE 2
City	:	WEST PLAINS
State	:	MO
Zip	:	65775-4235
Country	:	US
Telephone Number	:	417-255-1374
Fax Number	:	417-256-5040

Authorized Official
Title or Position	:	OWNER
Name	:	JEFFREY J HULL
Credential	:	MD
Telephone Number	:	417-255-1374

Provider Enumeration Date	:	12/02/2010
Last Update Date	:	12/02/2010

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