Provider Demographics
NPI:1013183656
Name:ADVANCED AUDIOLOGY HEARING SERVICES, INC
Entity Type:Organization
Organization Name:ADVANCED AUDIOLOGY HEARING SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DOCTOR OF AUDIOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BYLSMA
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:616-977-0379
Mailing Address - Street 1:1815 BRETON RD SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-4800
Mailing Address - Country:US
Mailing Address - Phone:616-977-0379
Mailing Address - Fax:616-977-0379
Practice Address - Street 1:1815 BRETON RD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-4800
Practice Address - Country:US
Practice Address - Phone:616-977-0379
Practice Address - Fax:616-977-0379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-04
Last Update Date:2008-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501002046174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI902637236Medicaid