=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942667316
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROFESSIONAL HEARING INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2016
-----------------------------------------------------
Last Update Date | 01/15/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1235 S CENTER RD STE 7
-----------------------------------------------------
City | BURTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48509-1700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-744-9000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1235 S CENTER RD STE 7
-----------------------------------------------------
City | BURTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48509-1700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ADAM KETTLEWELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 810-744-9000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332S00000X
-----------------------------------------------------
Taxonomy Name | Hearing Aid Equipment
-----------------------------------------------------
License Number | 3501005129
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------