1609979087 NPI number — AUDIOLOGY ASSOCIATES INC

Table of content: (NPI 1609979087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609979087 NPI number — AUDIOLOGY ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUDIOLOGY ASSOCIATES INC
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:
1609979087
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
214 E ELM
Provider Second Line Business Mailing Address:
SUITE 111
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48161-7085
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-241-4080
Provider Business Mailing Address Fax Number:
734-241-4798

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
214 E ELM
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48162-2678
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-241-4080
Provider Business Practice Location Address Fax Number:
734-241-4798
Provider Enumeration Date:
09/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HENRY
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
734-241-4080

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5501001058 . This is a "HEALTH ALLIANCE PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 04156 . This is a "NECP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 540E810410 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 640E810150 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: RH000001 . This is a "MESSA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 03321 . This is a "PARAMOUNT" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0E81041 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3328905 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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