Provider Demographics
NPI:1396223228
Name:WEST SHORE OTOLARYNGOLOGY PC
Entity Type:Organization
Organization Name:WEST SHORE OTOLARYNGOLOGY PC
Other - Org Name:WEST SHORE ENT & ALLERGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-739-9095
Mailing Address - Street 1:1450 FARR RD STE 5000
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49444-7789
Mailing Address - Country:US
Mailing Address - Phone:231-739-9095
Mailing Address - Fax:231-722-5147
Practice Address - Street 1:16760 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417
Practice Address - Country:US
Practice Address - Phone:616-414-9062
Practice Address - Fax:616-414-9063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-02
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Single Specialty