Provider Demographics
NPI:1821172685
Name:HAC HEARING AID CENTERS OF AMERICA INC
Entity Type:Organization
Organization Name:HAC HEARING AID CENTERS OF AMERICA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-243-2888
Mailing Address - Street 1:1350 W CENTRE AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-5361
Mailing Address - Country:US
Mailing Address - Phone:269-324-0301
Mailing Address - Fax:269-324-2733
Practice Address - Street 1:1350 W CENTRE AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-5361
Practice Address - Country:US
Practice Address - Phone:269-324-0301
Practice Address - Fax:269-324-2733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI902004116Medicaid
540C90317OtherBCBS
MI871870943Medicaid
MI902004116Medicaid