Provider Demographics
NPI:1336432483
Name:GRAND HEARING CENTER, LLC
Entity Type:Organization
Organization Name:GRAND HEARING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - AUDIOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOGEL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:517-526-0390
Mailing Address - Street 1:1330 E GRAND RIVER AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PORTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48875-1630
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1330 E GRAND RIVER AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PORTLAND
Practice Address - State:MI
Practice Address - Zip Code:48875-1630
Practice Address - Country:US
Practice Address - Phone:517-526-0390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000414231H00000X, 332BC3200X, 332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332S00000XSuppliersHearing Aid EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1285671164Medicaid
1285671164Medicare PIN
1285671164Medicare Oscar/Certification
MI1285671164Medicare UPIN