MEDICARE: WATERFORD HEARING CENTER

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	237600000X	Audiologist-Hearing Aid Fitter	23002485A	IN

General Provider Information

NPI Number	:	1376827303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WATERFORD HEARING CENTER

Provider Business Mailing Address
First Line	:	3777 N WOZNIAK RD
Second Line	:
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-9284
Country	:	US
Telephone Number	:	219-961-5077
Fax Number	:

Provider Business Practice Location Address
First Line	:	3777 N WOZNIAK RD
Second Line	:
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-9284
Country	:	US
Telephone Number	:	219-961-5077
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JESSIE B GRSKOVIC
Credential	:	AU.D.
Telephone Number	:	219-961-5077

Provider Enumeration Date	:	10/10/2011
Last Update Date	:	10/10/2011

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Directions to “WATERFORD HEARING CENTER ” Practice Location

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