Provider Demographics
NPI:1720242886
Name:MICHIGAN HEARING AID CENTER INC
Entity Type:Organization
Organization Name:MICHIGAN HEARING AID CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARCI
Authorized Official - Middle Name:K
Authorized Official - Last Name:TRYLES
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:269-383-4327
Mailing Address - Street 1:3429 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-2214
Mailing Address - Country:US
Mailing Address - Phone:269-383-4327
Mailing Address - Fax:269-383-5941
Practice Address - Street 1:3429 E MAIN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-2214
Practice Address - Country:US
Practice Address - Phone:269-383-4327
Practice Address - Fax:269-383-5941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000379237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI904289641Medicaid
MI19616Medicaid
MIOC90500OtherBLUE CROSS BLUE SHIELD
MIOC926350OtherBLUE CROSS BLUE SHIELD
MI=========050Medicaid
MIOC90500OtherBLUE CROSS BLUE SHIELD