Provider Demographics
NPI:1225283534
Name:AUDIO-AID RX
Entity Type:Organization
Organization Name:AUDIO-AID RX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:989-835-1219
Mailing Address - Street 1:6855 EASTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-7897
Mailing Address - Country:US
Mailing Address - Phone:989-835-1219
Mailing Address - Fax:989-835-7198
Practice Address - Street 1:6855 N. EASTMAN AVE.
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642
Practice Address - Country:US
Practice Address - Phone:989-835-1219
Practice Address - Fax:989-835-7198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000067332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI904508130Medicaid