MEDICARE: MARK O STUEMKE HEARING INSTRUMENT S

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	237700000X	Hearing Instrument Specialist	1270	NC
2	237700000X	Hearing Instrument Specialist	386N02	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1270	OTHER	NC	NC STATE HEARING AID DEALERS & FITTERS BOARD

General Provider Information

NPI Number	:	1760549463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK O STUEMKE HEARING INSTRUMENT S

Provider Business Mailing Address
First Line	:	644 STATESVILLE BLVD
Second Line	:	UNIT #3
City	:	SALISBURY
State	:	NC
Zip	:	28144-2280
Country	:	US
Telephone Number	:	704-633-6775
Fax Number	:	704-633-6799

Provider Business Practice Location Address
First Line	:	644 STATESVILLE BLVD
Second Line	:	UNIT #3
City	:	SALISBURY
State	:	NC
Zip	:	28144-2280
Country	:	US
Telephone Number	:	704-633-6775
Fax Number	:	704-633-6799

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	03/21/2013

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