=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871729731
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DMC BILLING ASSOCIATES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2009
-----------------------------------------------------
Last Update Date | 08/12/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3990 JOHN R ST STE 1702
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48201-2018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-720-5715
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3990 JOHN R SUITE 1702
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-720-5715
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FINANCE
-----------------------------------------------------
Name | MR. TIMOTHY RYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 810-720-5715
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------