1851360549 NPI number — VERSATILE HEARING SERVICE

Table of content: (NPI 1851360549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851360549 NPI number — VERSATILE HEARING SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VERSATILE HEARING SERVICE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BELTONE HEARING AID CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851360549
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2404 WILDWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49202-3927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-788-7677
Provider Business Mailing Address Fax Number:
517-788-7679

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2404 WILDWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49202-3927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-788-7677
Provider Business Practice Location Address Fax Number:
517-788-7679
Provider Enumeration Date:
03/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WAITE
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
OWNER, PRESIDENT
Authorized Official Telephone Number:
517-788-7677

Provider Taxonomy Codes

  • Taxonomy code: 332S00000X , with the licence number:  3501002419 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 903257607 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 540C802820 . This is a "BCBSM PIN NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 905258069 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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