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NPI Code Detail

MEDICARE: PROFESSIONAL HEARING & AUDIOLOGY SERVICES, INC.

MEDICARE: PROFESSIONAL HEARING & AUDIOLOGY SERVICES, INC.
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
1237600000XAudiologist-Hearing Aid Fitter5509MN

General Provider Information

NPI Number : 1750463865
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROFESSIONAL HEARING & AUDIOLOGY SERVICES, INC.
Provider Business Mailing Address
First Line : 1270 32ND AVE N
Second Line :
City : SAINT CLOUD
State : MN
Zip : 56303-1649
Country : US
Telephone Number : 320-259-1978
Fax Number : 320-259-0362
Provider Business Practice Location Address
First Line : 1270 32ND AVE N
Second Line :
City : SAINT CLOUD
State : MN
Zip : 56303-1649
Country : US
Telephone Number : 320-259-1978
Fax Number : 320-259-0362
Authorized Official
Title or Position : AUDIOLOGIST/CEO
Name : RICHARD K BROWN
Credential : M.A., CCC-A
Telephone Number : 320-259-1978
Provider Enumeration Date : 10/19/2006
Last Update Date : 08/22/2020

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