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NPI Code Detail

MEDICARE: MR. BRYAN BLACK BC-HIS, A.C.A.

MEDICARE: MR. BRYAN BLACK BC-HIS, A.C.A.
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
1237700000XHearing Instrument Specialist2349OH

General Provider Information

NPI Number : 1952846503
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRYAN BLACK BC-HIS, A.C.A.
Provider Business Mailing Address
First Line : 101 E ALEX BELL RD STE 166
Second Line :
City : CENTERVILLE
State : OH
Zip : 45459-2752
Country : US
Telephone Number : 937-436-2358
Fax Number :
Provider Business Practice Location Address
First Line : 101 E ALEX BELL RD STE 166
Second Line :
City : CENTERVILLE
State : OH
Zip : 45459-2752
Country : US
Telephone Number : 937-436-2358
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2017
Last Update Date : 01/05/2017

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