MEDICARE: COMMUNITY HEARING CENTER 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	261QH0700X	Hearing and Speech Clinic/Center	1601000599	MI

General Provider Information

NPI Number	:	1568903185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY HEARING CENTER LLC

Provider Business Mailing Address
First Line	:	2027 4TH ST
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-4572
Country	:	US
Telephone Number	:	740-804-1131
Fax Number	:

Provider Business Practice Location Address
First Line	:	2027 4TH ST
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-4572
Country	:	US
Telephone Number	:	740-804-1131
Fax Number	:

Authorized Official
Title or Position	:	OWNER/AUDIOLOGIST
Name	:	DR. KELLI L BOGUE
Credential	:	AU.D.
Telephone Number	:	517-817-6017

Provider Enumeration Date	:	03/15/2017
Last Update Date	:	05/25/2017

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