MEDICARE: AUDIO VISUAL CENTRAL NORTH, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1023659919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUDIO VISUAL CENTRAL NORTH, LLC

Provider Business Mailing Address
First Line	:	24776 CRESTVIEW CT
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48335-1506
Country	:	US
Telephone Number	:	248-471-3372
Fax Number	:

Provider Business Practice Location Address
First Line	:	702 S NICOLET ST
Second Line	:
City	:	MACKINAW CITY
State	:	MI
Zip	:	49701-9767
Country	:	US
Telephone Number	:	248-471-3371
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. GEORGE BOEHRINGER
Credential	:
Telephone Number	:	248-471-3371

Provider Enumeration Date	:	10/02/2019
Last Update Date	:	01/30/2020

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