Provider Demographics
NPI:1235397969
Name:MICHIANA HEARING CARE CENTER, P.C.
Entity Type:Organization
Organization Name:MICHIANA HEARING CARE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:574-232-3100
Mailing Address - Street 1:1001 HICKORY ROAD
Mailing Address - Street 2:SUITE 8A
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46615-3700
Mailing Address - Country:US
Mailing Address - Phone:574-232-3100
Mailing Address - Fax:574-232-4100
Practice Address - Street 1:1001 N HICKORY RD
Practice Address - Street 2:SUITE 8A
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615-3702
Practice Address - Country:US
Practice Address - Phone:574-232-3100
Practice Address - Fax:574-232-4100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0115322477261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200423490AMedicaid
IN200423490AMedicaid