Provider Demographics
NPI:1467617027
Name:MIDWEST HEARING & AUDIOLOGY, INC.
Entity Type:Organization
Organization Name:MIDWEST HEARING & AUDIOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:SIEGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-A
Authorized Official - Phone:765-489-1388
Mailing Address - Street 1:115 E MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HAGERSTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47346-1302
Mailing Address - Country:US
Mailing Address - Phone:765-489-1388
Mailing Address - Fax:765-489-4228
Practice Address - Street 1:115 E MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:HAGERSTOWN
Practice Address - State:IN
Practice Address - Zip Code:47346-1302
Practice Address - Country:US
Practice Address - Phone:765-489-1388
Practice Address - Fax:765-489-4228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002155A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000215970OtherBLUE CROSS BLUE SHIELD