=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881865947
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AUDIO AID OF CENTRAL MICHIGAN, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2008
-----------------------------------------------------
Last Update Date | 10/08/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 322 S. LAFAYETTE STREET SUITE D
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-225-9892
-----------------------------------------------------
Fax | 616-225-8936
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 322 S. LAFAYETTE STREET SUITE D
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-225-9892
-----------------------------------------------------
Fax | 616-225-8936
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | PEGGY JO FRANK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 616-225-9892
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 1601000047
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | 3501002249
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 237600000X
-----------------------------------------------------
Taxonomy Name | Audiologist-Hearing Aid Fitter
-----------------------------------------------------
License Number | 1601000047
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------