Provider Demographics
NPI:1720375397
Name:AUDIO AID RX OF MIDLAND, LLC
Entity Type:Organization
Organization Name:AUDIO AID RX OF MIDLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:989-835-1219
Mailing Address - Street 1:1504 HARCREST DR STE 3
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4717
Mailing Address - Country:US
Mailing Address - Phone:989-835-1219
Mailing Address - Fax:
Practice Address - Street 1:1504 HARCREST DR STE 3
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4717
Practice Address - Country:US
Practice Address - Phone:989-835-1219
Practice Address - Fax:989-835-7198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-05
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000067237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty