=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669632998
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HERITAGE HEARING CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2008
-----------------------------------------------------
Last Update Date | 06/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 705 10TH AVE
-----------------------------------------------------
City | MENOMINEE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49858-3012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-864-2945
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 705 10TH AVE
-----------------------------------------------------
City | MENOMINEE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49858-3012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-864-2945
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUDIOLOGIST
-----------------------------------------------------
Name | DR. JOHANNA ZUEHLS
-----------------------------------------------------
Credential | AU.D.
-----------------------------------------------------
Telephone | 906-864-2945
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332S00000X
-----------------------------------------------------
Taxonomy Name | Hearing Aid Equipment
-----------------------------------------------------
License Number | 1601000404
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------