MEDICARE: DELTA HEARING 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	A2092	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710136213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELTA HEARING SERVICES

Provider Business Mailing Address
First Line	:	2359 HIGHWAY 1 S
Second Line	:
City	:	GREENVILLE
State	:	MS
Zip	:	38701-8337
Country	:	US
Telephone Number	:	662-335-9434
Fax Number	:

Provider Business Practice Location Address
First Line	:	2359 HIGHWAY 1 S
Second Line	:
City	:	GREENVILLE
State	:	MS
Zip	:	38701-8337
Country	:	US
Telephone Number	:	662-335-9434
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	ROBERT S MOORE
Credential	:	M.A.CCC-A
Telephone Number	:	662-335-9434

Provider Enumeration Date	:	09/09/2008
Last Update Date	:	09/09/2008

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Directions to “DELTA HEARING SERVICES ” Practice Location

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