MEDICARE: SOUTHERN MEDICAL HEARING CENTERS

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	1336	TN

General Provider Information

NPI Number	:	1710379458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN MEDICAL HEARING CENTERS

Provider Business Mailing Address
First Line	:	4488 FRONTAGE RD NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-2903
Country	:	US
Telephone Number	:	423-328-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	4488 FRONTAGE RD NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-2903
Country	:	US
Telephone Number	:	423-328-1200
Fax Number	:

Authorized Official
Title or Position	:	OWNER/AUDIOLOGIST
Name	:	STEPHANY LEE SUN
Credential	:	AU.D.
Telephone Number	:	423-328-1200

Provider Enumeration Date	:	03/03/2015
Last Update Date	:	03/03/2015

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