MEDICARE: RICHARD PRUETT BC-HIS

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	13	CO

General Provider Information

NPI Number	:	1811177447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD PRUETT BC-HIS

Provider Business Mailing Address
First Line	:	2310 KIPLING ST
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80215-1524
Country	:	US
Telephone Number	:	303-237-2923
Fax Number	:

Provider Business Practice Location Address
First Line	:	2310 KIPLING ST
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80215-1524
Country	:	US
Telephone Number	:	303-237-2923
Fax Number	:

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

Provider Enumeration Date	:	11/12/2007
Last Update Date	:	11/12/2007

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