Provider Demographics
NPI:1336363225
Name:MASS AUDIOLOGY & HEARING SERVICE INC
Entity Type:Organization
Organization Name:MASS AUDIOLOGY & HEARING SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:508-583-5800
Mailing Address - Street 1:165 WESTGATE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301
Mailing Address - Country:US
Mailing Address - Phone:508-583-5800
Mailing Address - Fax:508-580-3152
Practice Address - Street 1:165 WESTGATE DRIVE
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:508-583-5800
Practice Address - Fax:508-580-3152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9774416Medicaid
MA014566OtherBLUE CROSS
ME809343OtherHARVARD PILGRIM
MA000000036767OtherBMC HEALTHNET
MA805516OtherTUFTS
=========Medicare UPIN
MA014566Medicare ID - Type Unspecified