Provider Demographics
NPI:1720152986
Name:GRACE HEARING INSTRUMENTS, INC.
Entity Type:Organization
Organization Name:GRACE HEARING INSTRUMENTS, INC.
Other - Org Name:AUDOLOGY SERVICES & HEARING AID CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GRACE
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:712-322-8393
Mailing Address - Street 1:530 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-4413
Mailing Address - Country:US
Mailing Address - Phone:712-322-8393
Mailing Address - Fax:712-322-2660
Practice Address - Street 1:530 E BROADWAY
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4413
Practice Address - Country:US
Practice Address - Phone:712-322-8393
Practice Address - Fax:712-322-2660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA231H00000X231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0126078Medicaid
IA0126078Medicaid