MEDICARE: PETALUMA VALLEY HEARING CENTER

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1700103827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETALUMA VALLEY HEARING CENTER

Provider Business Mailing Address
First Line	:	106 LYNCH CREEK WAY
Second Line	:	SUITE 9A
City	:	PETALUMA
State	:	CA
Zip	:	94954-2356
Country	:	US
Telephone Number	:	866-853-3499
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 LYNCH CREEK WAY
Second Line	:	SUITE 9A
City	:	PETALUMA
State	:	CA
Zip	:	94954-2356
Country	:	US
Telephone Number	:	866-853-3499
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. MICHELLE A PILTCH
Credential	:
Telephone Number	:	707-762-0103

Provider Enumeration Date	:	04/28/2010
Last Update Date	:	04/28/2010

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