Provider Demographics
NPI:1225104003
Name:HEARING SERVICES OF BAD AXE
Entity Type:Organization
Organization Name:HEARING SERVICES OF BAD AXE
Other - Org Name:HEARING CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:KGLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA CC-A
Authorized Official - Phone:989-269-4327
Mailing Address - Street 1:1252 SAND BEACH RD
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-8817
Mailing Address - Country:US
Mailing Address - Phone:989-269-4327
Mailing Address - Fax:989-269-2251
Practice Address - Street 1:1252 SAND BEACH RD
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-8817
Practice Address - Country:US
Practice Address - Phone:989-269-4327
Practice Address - Fax:989-269-2251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501001531237700000X
MI231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI640C22601OtherBCBA TESTING
MI124005OtherGREAT LAKES MEDICAID
MI540C20269OtherBCBS DISPENSING
MI124005OtherGREAT LAKES MEDICAID
MI0G42600Medicare ID - Type UnspecifiedTESTING