Provider Demographics
NPI:1396921110
Name:DYNAMIC AUDIOLOGY INC
Entity type:Organization
Organization Name:DYNAMIC AUDIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-887-7660
Mailing Address - Street 1:3410 BELLE CHASE WAY
Mailing Address - Street 2:SUITE 700
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4282
Mailing Address - Country:US
Mailing Address - Phone:517-887-7660
Mailing Address - Fax:517-887-7661
Practice Address - Street 1:3410 BELLE CHASE WAY
Practice Address - Street 2:SUITE 700
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4282
Practice Address - Country:US
Practice Address - Phone:517-887-7660
Practice Address - Fax:517-887-7661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200000000506OtherPHPMM
MI4684351Medicaid
MI4683710Medicaid
MIOC31283OtherBCBSM