Provider Demographics
NPI:1609063551
Name:WEST MICHIGAN HEARING SPECIALISTS LLC
Entity Type:Organization
Organization Name:WEST MICHIGAN HEARING SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CCC-A
Authorized Official - Phone:269-683-0800
Mailing Address - Street 1:24 N SAINT JOSEPH AVE
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2263
Mailing Address - Country:US
Mailing Address - Phone:269-683-0800
Mailing Address - Fax:269-683-7638
Practice Address - Street 1:24 N SAINT JOSEPH AVE
Practice Address - Street 2:SUITE C-1
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2263
Practice Address - Country:US
Practice Address - Phone:269-683-0800
Practice Address - Fax:269-683-7638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1037885237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2996538Medicaid
MI4439159Medicaid
MI640A126090OtherBCBS
MI540A103560OtherBCBS
MI540A103560OtherBCBS
MI=========050Medicaid
MI=========050Medicaid