MEDICARE: VERSATILE HEARING SERVICE

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	332S00000X	Hearing Aid Equipment	3501002419	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	540C802820	OTHER	MI	BCBSM PIN NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851360549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERSATILE HEARING SERVICE

Provider Business Mailing Address
First Line	:	2404 WILDWOOD AVE
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49202-3927
Country	:	US
Telephone Number	:	517-788-7677
Fax Number	:	517-788-7679

Provider Business Practice Location Address
First Line	:	2404 WILDWOOD AVE
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49202-3927
Country	:	US
Telephone Number	:	517-788-7677
Fax Number	:	517-788-7679

Authorized Official
Title or Position	:	OWNER, PRESIDENT
Name	:	MRS. SUSAN MARIE WAITE
Credential	:	NBC-HIS
Telephone Number	:	517-788-7677

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	06/13/2008

Similar Medicare Providers

1629242789 — VERSATILE HEARING SERVICES
Practice Location Address:

2404 WILDWOOD AVE
JACKSON, MI
49202-3927

Practice Phone: 517-788-7677
Practice Fax: 517-788-7679

1164753950 — SUSAN MARIE WAITE NBC-HIS
Practice Location Address:

2404 WILDWOOD AVE
JACKSON, MI
49202-3927

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Practice Fax: 517-788-7679

1922966027 — TSERING LAMA
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1598841256 — ROSEANNE DISHMAN ELLIS DC
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1356834618 — NTW BEHAVIORAL HEALTH SERVICES LLC
Practice Location Address:

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Practice Fax:

1972462604 — DAKOTA WILT
Practice Location Address:

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Directions to “VERSATILE HEARING SERVICE ” Practice Location

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