1447378773 NPI number — PERSONALIZED HEARING CARE

Table of content: (NPI 1447378773)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447378773 NPI number — PERSONALIZED HEARING CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERSONALIZED HEARING CARE
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:
Provider Other Organization Name Type Code:
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:
1447378773
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35337 WARREN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTLAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48185-2013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-467-5100
Provider Business Mailing Address Fax Number:
734-467-5103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35337 WARREN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTLAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48185-2013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-467-5100
Provider Business Practice Location Address Fax Number:
734-467-5103
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JAGACKI
Authorized Official First Name:
KARISSA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
AUDIOLOGIST
Authorized Official Telephone Number:
734-467-5100

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  1601000113 , 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: 640H227530 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 540H104260 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4433772 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0H10426 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 237600000X . This is a "PROVIDER TAXONOMIES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4704347 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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