Provider Demographics
NPI:1235303538
Name:ADVANCED AUDIOLOGY, LLC
Entity Type:Organization
Organization Name:ADVANCED AUDIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:AUD, CCC-A
Authorized Official - Phone:517-669-8080
Mailing Address - Street 1:12775 ESCANABA DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-8615
Mailing Address - Country:US
Mailing Address - Phone:517-669-8080
Mailing Address - Fax:517-669-8070
Practice Address - Street 1:12775 ESCANABA DR
Practice Address - Street 2:SUITE 3
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-8615
Practice Address - Country:US
Practice Address - Phone:517-669-8080
Practice Address - Fax:517-669-8070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000153237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
200000000483OtherPHYSICIANS HEALTH PLAN MM
MI80-4678229Medicaid
MI1932141983OtherNPI, TYPE 1
MI1007674OtherMCLAREN HEALTH PLAN
MI1007674OtherMCLAREN HEALTH ADVANTAGE
MI54OA900140OtherBLUE CROSS BLUE SHIELD MI
MI64OA900130OtherBLUE CROSS BLUE SHIELD MI
MI90-4658208Medicaid
MI1932141983OtherNPI, TYPE 1
200000000483OtherPHYSICIANS HEALTH PLAN MM