Healthcare Provider Details

I. General information

NPI: 1023659919
Provider Name (Legal Business Name): AUDIO VISUAL CENTRAL NORTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 S NICOLET ST
MACKINAW CITY MI
49701-9767
US

IV. Provider business mailing address

24776 CRESTVIEW CT
FARMINGTON HILLS MI
48335-1506
US

V. Phone/Fax

Practice location:
  • Phone: 248-471-3371
  • Fax:
Mailing address:
  • Phone: 248-471-3372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. GEORGE BOEHRINGER
Title or Position: PRESIDENT
Credential:
Phone: 248-471-3371