Provider Demographics
NPI:1245333624
Name:RIVERSIDE HEARING SERVICES
Entity type:Organization
Organization Name:RIVERSIDE HEARING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:NASTAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-486-4444
Mailing Address - Street 1:14600 KING RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-7952
Mailing Address - Country:US
Mailing Address - Phone:734-486-4444
Mailing Address - Fax:734-486-5555
Practice Address - Street 1:14600 KING RD
Practice Address - Street 2:SUITE D
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-7952
Practice Address - Country:US
Practice Address - Phone:734-486-4444
Practice Address - Fax:734-486-5555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5352130OtherAETNA HMO & MC
MI640H218730OtherBCBSM
MI4189127Medicaid
MI540H218800OtherBCBSM
MI4189127Medicaid
S07313Medicare UPIN