1720242886 NPI number — MICHIGAN HEARING AID CENTER INC

Table of content: (NPI 1720242886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720242886 NPI number — MICHIGAN HEARING AID CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHIGAN HEARING AID CENTER 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:
1720242886
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3429 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALAMAZOO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49048-2214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-383-4327
Provider Business Mailing Address Fax Number:
269-383-5941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3429 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KALAMAZOO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49048-2214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-383-4327
Provider Business Practice Location Address Fax Number:
269-383-5941
Provider Enumeration Date:
07/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
TRYLES
Authorized Official First Name:
DARCI
Authorized Official Middle Name:
K
Authorized Official Title or Position:
OWNER/AUDIOLOGIST
Authorized Official Telephone Number:
269-383-4327

Provider Taxonomy Codes

  • Taxonomy code: 237600000X , with the licence number:  1601000379 , 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: 904289641 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 19616 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: OC90500 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: OC926350 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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