MEDICARE: QUALITY LIFE HEARING CENTER, LLC

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	332S00000X	Hearing Aid Equipment	3501003208	MI

General Provider Information

NPI Number	:	1851604177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY LIFE HEARING CENTER, LLC

Provider Business Mailing Address
First Line	:	710 S BROWN ST
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-1429
Country	:	US
Telephone Number	:	517-788-8000
Fax Number	:	517-788-3898

Provider Business Practice Location Address
First Line	:	710 S BROWN ST
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-1429
Country	:	US
Telephone Number	:	517-788-8000
Fax Number	:	517-788-3898

Authorized Official
Title or Position	:	PRESIDENT/HEARING AID SPECIALIST
Name	:	MRS. JOHNENE ANN GASTON
Credential	:	BC-HIS
Telephone Number	:	517-788-8000

Provider Enumeration Date	:	07/15/2010
Last Update Date	:	07/15/2010

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