Provider Demographics
NPI:1700053568
Name:HAGEMAN AUDIOLOGY & HEARING AIDS LLC
Entity Type:Organization
Organization Name:HAGEMAN AUDIOLOGY & HEARING AIDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:HAGEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:616-285-3733
Mailing Address - Street 1:2505 EAST PARIS AVE SE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2422
Mailing Address - Country:US
Mailing Address - Phone:616-285-3733
Mailing Address - Fax:616-288-3745
Practice Address - Street 1:2505 EAST PARIS AVE SE
Practice Address - Street 2:SUITE 170
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2422
Practice Address - Country:US
Practice Address - Phone:616-285-3733
Practice Address - Fax:616-288-3745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000046332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4847180Medicaid
MI4956943OtherMEDICAID TYPE 90
MI640D115780OtherBLUE CROSS BLUE SHIELD
MI640D115780OtherBLUE CROSS BLUE SHIELD