Provider Demographics
NPI:1851360549
Name:VERSATILE HEARING SERVICE
Entity Type:Organization
Organization Name:VERSATILE HEARING SERVICE
Other - Org Name:BELTONE HEARING AID CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WAITE
Authorized Official - Suffix:
Authorized Official - Credentials:NBC-HIS
Authorized Official - Phone:517-788-7677
Mailing Address - Street 1:2404 WILDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-3927
Mailing Address - Country:US
Mailing Address - Phone:517-788-7677
Mailing Address - Fax:517-788-7679
Practice Address - Street 1:2404 WILDWOOD AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-3927
Practice Address - Country:US
Practice Address - Phone:517-788-7677
Practice Address - Fax:517-788-7679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501002419332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI903257607Medicaid
MI540C802820OtherBCBSM PIN NUMBER
MI905258069Medicaid