Provider Demographics
NPI:1033482203
Name:ACOUSTIC AUDIO SERVICES OF MICHIANA, INC.
Entity Type:Organization
Organization Name:ACOUSTIC AUDIO SERVICES OF MICHIANA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR OF AUDIOLOGY
Authorized Official - Phone:574-287-7221
Mailing Address - Street 1:808 S MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-3123
Mailing Address - Country:US
Mailing Address - Phone:574-287-7221
Mailing Address - Fax:574-233-4756
Practice Address - Street 1:808 S MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-3123
Practice Address - Country:US
Practice Address - Phone:574-287-7221
Practice Address - Fax:574-233-4756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-17
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23001161A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000250486OtherANTHEM BLUE CROSS BLUE SHIELD
IN100223310AMedicaid
IN100223310AMedicaid