Provider Demographics
NPI:1578972063
Name:LIFETIME HEARING SERVICES LLC
Entity Type:Organization
Organization Name:LIFETIME HEARING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEIER
Authorized Official - Suffix:
Authorized Official - Credentials:MA-CCC-A
Authorized Official - Phone:810-364-1170
Mailing Address - Street 1:1273 GRATIOT BLVD
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48040-2303
Mailing Address - Country:US
Mailing Address - Phone:810-364-1170
Mailing Address - Fax:810-364-2946
Practice Address - Street 1:1273 GRATIOT BLVD
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48040-2303
Practice Address - Country:US
Practice Address - Phone:810-364-1170
Practice Address - Fax:810-364-2946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M29380Medicare PIN