Provider Demographics
NPI:1750653671
Name:HARRINGTON, JOHN M (HEARING AID DEALER)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:HARRINGTON
Suffix:
Gender:M
Credentials:HEARING AID DEALER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 E FRONT ST
Mailing Address - Street 2:
Mailing Address - City:BUCHANAN
Mailing Address - State:MI
Mailing Address - Zip Code:49107-1499
Mailing Address - Country:US
Mailing Address - Phone:269-695-3511
Mailing Address - Fax:269-695-7135
Practice Address - Street 1:802 E FRONT ST
Practice Address - Street 2:
Practice Address - City:BUCHANAN
Practice Address - State:MI
Practice Address - Zip Code:49107-1499
Practice Address - Country:US
Practice Address - Phone:269-695-3511
Practice Address - Fax:269-695-7135
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501001753237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540A10292OtherBLUE CROSS BLUE SHIELD