Healthcare Provider Details

I. General information

NPI: 1396703971
Provider Name (Legal Business Name): PROFESSIONAL HEARING SERVICES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 RENAISSANCE DR STE 100
SAINT JOSEPH MI
49085-2180
US

IV. Provider business mailing address

511 RENAISSANCE DR STE 100
SAINT JOSEPH MI
49085-2180
US

V. Phone/Fax

Practice location:
  • Phone: 269-982-3444
  • Fax: 269-982-3445
Mailing address:
  • Phone: 269-982-3444
  • Fax: 269-982-3445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIMBERLY ANN RICE
Title or Position: A/R MANAGER
Credential:
Phone: 269-982-3444