MEDICARE: TRI-STATE HEARING, LLC

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	261QH0700X	Hearing and Speech Clinic/Center	AUD003986	GA

General Provider Information

NPI Number	:	1821490020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-STATE HEARING, LLC

Provider Business Mailing Address
First Line	:	2025 BUENA VISTA DR.
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35216-3701
Country	:	US
Telephone Number	:	205-822-0700
Fax Number	:

Provider Business Practice Location Address
First Line	:	227 MARKET PLACE CONNECTOR
Second Line	:
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-3542
Country	:	US
Telephone Number	:	770-487-9030
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. JAKE T HENDON
Credential	:
Telephone Number	:	205-822-0700

Provider Enumeration Date	:	09/18/2014
Last Update Date	:	02/17/2017

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