MEDICARE: ROBERT BRADFORD ISON 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	100432	KY

General Provider Information

NPI Number	:	1871015420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT BRADFORD ISON HIS

Provider Business Mailing Address
First Line	:	PO BOX 1002
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42241-1002
Country	:	US
Telephone Number	:	270-886-8468
Fax Number	:	270-886-8472

Provider Business Practice Location Address
First Line	:	1720 S VIRGINIA ST
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42240-3684
Country	:	US
Telephone Number	:	270-886-8468
Fax Number	:	270-886-8472

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

Provider Enumeration Date	:	07/14/2017
Last Update Date	:	01/27/2022

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