MEDICARE: SOUTHERN NEVADA AUDIOLOGY

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		NV
2	237600000X	Audiologist-Hearing Aid Fitter		NV

General Provider Information

NPI Number	:	1588922314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN NEVADA AUDIOLOGY

Provider Business Mailing Address
First Line	:	6061 S. FORT APACHE #130
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5578
Country	:	US
Telephone Number	:	703-990-1568
Fax Number	:	702-943-1408

Provider Business Practice Location Address
First Line	:	6061 S. FORT APACHE #130
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5578
Country	:	US
Telephone Number	:	703-990-1568
Fax Number	:	702-943-1408

Authorized Official
Title or Position	:	OWNER/AUDIOLOGIST
Name	:	MRS. CARRIE LYNN PAGE-UNKEL
Credential	:	M.S., CCC-A
Telephone Number	:	702-990-1568

Provider Enumeration Date	:	04/30/2012
Last Update Date	:	04/30/2012

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