Provider Demographics
NPI:1396703971
Name:PROFESSIONAL HEARING SERVICES, LTD
Entity type:Organization
Organization Name:PROFESSIONAL HEARING SERVICES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:A/R MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-982-3444
Mailing Address - Street 1:511 RENAISSANCE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-2180
Mailing Address - Country:US
Mailing Address - Phone:269-982-3444
Mailing Address - Fax:269-982-3445
Practice Address - Street 1:511 RENAISSANCE DR
Practice Address - Street 2:STE 100
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2180
Practice Address - Country:US
Practice Address - Phone:269-982-3444
Practice Address - Fax:269-982-3445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
640A126030OtherBLUE CROSS BLUE SHIELD MI
MI0A12603OtherMEDICARE ADVANTAGE BCBS