Provider Demographics
NPI:1689860546
Name:WESTERN MICHIGAN HEARING SERVICES, INC.
Entity Type:Organization
Organization Name:WESTERN MICHIGAN HEARING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SZUMOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:616-942-1818
Mailing Address - Street 1:4232 29TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-1936
Mailing Address - Country:US
Mailing Address - Phone:616-942-1818
Mailing Address - Fax:616-942-6567
Practice Address - Street 1:4232 29TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-1936
Practice Address - Country:US
Practice Address - Phone:616-942-1818
Practice Address - Fax:616-942-6567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000019231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM58380Medicare PIN