MEDICARE: THE HEARING CLINIC, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237600000X	Audiologist-Hearing Aid Fitter

General Provider Information

NPI Number	:	1205056314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE HEARING CLINIC, INC

Provider Business Mailing Address
First Line	:	751 KENMOOR AVE SE STE B
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-2391
Country	:	US
Telephone Number	:	616-954-1895
Fax Number	:	616-954-2093

Provider Business Practice Location Address
First Line	:	4301 CANAL AVE SW
Second Line	:	SUITE 203
City	:	GRANDVILLE
State	:	MI
Zip	:	49418-2667
Country	:	US
Telephone Number	:	616-257-7880
Fax Number	:	616-257-0580

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	AMY B DONKER
Credential	:
Telephone Number	:	616-954-1895

Provider Enumeration Date	:	04/30/2007
Last Update Date	:	08/22/2020

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