Provider Demographics
NPI:1609922350
Name:ROCHESTER HEARING SERVICE, INC.
Entity Type:Organization
Organization Name:ROCHESTER HEARING SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BYLE
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:248-608-8881
Mailing Address - Street 1:134 W UNIVERSITY DR STE 203
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1955
Mailing Address - Country:US
Mailing Address - Phone:248-608-8881
Mailing Address - Fax:248-608-8879
Practice Address - Street 1:134 W UNIVERSITY DR STE 203
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1955
Practice Address - Country:US
Practice Address - Phone:248-608-8881
Practice Address - Fax:248-608-8879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILB000068237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540F30565OtherMICHIGAN BLUE CROSS
MILB000068OtherMICHIGAN BLUE CROSS
MI0F31503OtherBLUE CARE NETWORK
MI640F32642OtherMICHIGAN BLUE CROSS
MIOM35220Medicare ID - Type Unspecified