Healthcare Provider Details

I. General information

NPI: 1437476926
Provider Name (Legal Business Name): MOTT CHILDREN'S HEALTH CENTER-AUDIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 TUURI PL
FLINT MI
48503-2465
US

IV. Provider business mailing address

806 TUURI PL
FLINT MI
48503-2465
US

V. Phone/Fax

Practice location:
  • Phone: 810-767-5750
  • Fax: 810-237-7582
Mailing address:
  • Phone: 810-767-5750
  • Fax: 810-237-7582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK WILLIAM PASCOE
Title or Position: VICE PRESIDENT, FINANCE
Credential:
Phone: 810-237-7570