Provider Demographics
NPI:1952626608
Name:BELTONE OF NORTHERN MICHIGAN
Entity Type:Organization
Organization Name:BELTONE OF NORTHERN MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SYSAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-922-9922
Mailing Address - Street 1:3200 S AIRPORT RD W
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-8117
Mailing Address - Country:US
Mailing Address - Phone:231-922-9922
Mailing Address - Fax:877-883-9887
Practice Address - Street 1:3200 S AIRPORT RD W
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-8117
Practice Address - Country:US
Practice Address - Phone:231-922-9922
Practice Address - Fax:877-883-9887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment