Provider Demographics
NPI:1477574705
Name:MIDMICHIGAN AUDIOLOGY SERVICES INC
Entity Type:Organization
Organization Name:MIDMICHIGAN AUDIOLOGY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-839-6201
Mailing Address - Street 1:PO BOX 1446
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48641-1446
Mailing Address - Country:US
Mailing Address - Phone:989-839-6201
Mailing Address - Fax:989-839-6202
Practice Address - Street 1:2520 MCCANDLESS DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6115
Practice Address - Country:US
Practice Address - Phone:989-839-6201
Practice Address - Fax:989-839-6202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000045231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540E602710OtherBCBS
MI040E610050OtherBCBS
MI640E626040OtherBCBS
MI640E626040OtherBCBS