MEDICARE: PROFESSIONAL HEARING SERVICES, LTD

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	231H00000X	Audiologist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0A12603	OTHER	MI	MEDICARE ADVANTAGE BCBS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	640A126030	OTHER		BLUE CROSS BLUE SHIELD MI

General Provider Information

NPI Number	:	1396703971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL HEARING SERVICES, LTD

Provider Business Mailing Address
First Line	:	511 RENAISSANCE DR
Second Line	:	STE 100
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-2180
Country	:	US
Telephone Number	:	269-982-3444
Fax Number	:	269-982-3445

Provider Business Practice Location Address
First Line	:	511 RENAISSANCE DR
Second Line	:	STE 100
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-2180
Country	:	US
Telephone Number	:	269-982-3444
Fax Number	:	269-982-3445

Authorized Official
Title or Position	:	A/R MANAGER
Name	:	MRS. KIMBERLY ANN RICE
Credential	:
Telephone Number	:	269-982-3444

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	04/12/2023

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Directions to “PROFESSIONAL HEARING SERVICES, LTD ” Practice Location

Language	Start Address	Practice Location

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