Provider Demographics
NPI:1508910704
Name:CENTRAL MICHIGAN AUDIOLOGY LLC
Entity Type:Organization
Organization Name:CENTRAL MICHIGAN AUDIOLOGY LLC
Other - Org Name:ALLIED HEARING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND DR AUD
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:989-773-1209
Mailing Address - Street 1:1290 E BROOMFIELD ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-4449
Mailing Address - Country:US
Mailing Address - Phone:989-773-1209
Mailing Address - Fax:989-773-4267
Practice Address - Street 1:1290 E BROOMFIELD ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-4449
Practice Address - Country:US
Practice Address - Phone:989-773-1209
Practice Address - Fax:989-773-4267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000080231H00000X
MI1601000386231H00000X
MI3501002686237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty