MEDICARE: AMERICAN HEARING AID CENTER AND AUDIOLOGY SERVICES

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	3684	OK

General Provider Information

NPI Number	:	1699072280
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN HEARING AID CENTER AND AUDIOLOGY SERVICES

Provider Business Mailing Address
First Line	:	5820 N MAY AVE
Second Line	:	SUITE C
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4282
Country	:	US
Telephone Number	:	405-842-8377
Fax Number	:

Provider Business Practice Location Address
First Line	:	5820 N MAY AVE
Second Line	:	SUITE C
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4282
Country	:	US
Telephone Number	:	405-842-8377
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. KRISTY WITZKE
Credential	:	AU.D.
Telephone Number	:	405-842-8377

Provider Enumeration Date	:	02/17/2011
Last Update Date	:	02/17/2011

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