Provider Demographics
NPI:1104878503
Name:MUSKEGON HEARING & SPEECH CENTER, INC.
Entity type:Organization
Organization Name:MUSKEGON HEARING & SPEECH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MA-CCC-A
Authorized Official - Phone:231-737-0527
Mailing Address - Street 1:1155 E. SHERMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1450
Mailing Address - Country:US
Mailing Address - Phone:231-737-0527
Mailing Address - Fax:231-733-4093
Practice Address - Street 1:1155 E. SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1450
Practice Address - Country:US
Practice Address - Phone:231-737-0527
Practice Address - Fax:231-733-4093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISB013583231H00000X
MIKS001083231H00000X
MISB002162231H00000X
MIKS761379231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI804678588Medicaid
MI640F110510OtherBCBC GROUP SERVICE
MI902613459Medicaid
MI540F110520OtherBCBS HEARING AID GROUP
MI902613459Medicaid