MEDICARE: IDEAL PRACTICE MANAGEMENT GROUP MI LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	231H00000X	Audiologist
2	237700000X	Hearing Instrument Specialist
3	332S00000X	Hearing Aid Equipment
4	237600000X	Audiologist-Hearing Aid Fitter

General Provider Information

NPI Number	:	1013466408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDEAL PRACTICE MANAGEMENT GROUP MI LLC

Provider Business Mailing Address
First Line	:	35 WATERVIEW BLVD STE 305
Second Line	:
City	:	PARSIPPANY
State	:	NJ
Zip	:	07054-7604
Country	:	US
Telephone Number	:	973-588-7266
Fax Number	:	973-588-7268

Provider Business Practice Location Address
First Line	:	106 SYLVIS ST
Second Line	:
City	:	DICKSON
State	:	TN
Zip	:	37055-6314
Country	:	US
Telephone Number	:	615-446-8565
Fax Number	:

Authorized Official
Title or Position	:	VP FINANCE
Name	:	MRS. VICKI COLE
Credential	:
Telephone Number	:	331-305-8086

Provider Enumeration Date	:	09/26/2016
Last Update Date	:	02/03/2026

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