Provider Demographics
NPI:1245277839
Name:MCDONALD HEARING AID, INC.
Entity type:Organization
Organization Name:MCDONALD HEARING AID, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:ASSOCIATE IN BUSINES
Authorized Official - Phone:616-459-7111
Mailing Address - Street 1:330 FULLER AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3631
Mailing Address - Country:US
Mailing Address - Phone:616-459-7111
Mailing Address - Fax:616-459-8277
Practice Address - Street 1:330 FULLER AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-3631
Practice Address - Country:US
Practice Address - Phone:616-459-7111
Practice Address - Fax:616-459-8277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501000275237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI64OD126230Medicare UPIN
MIOM74090Medicare ID - Type UnspecifiedMEDICARE