Provider Demographics
NPI:1699173187
Name:ST CLAIR SHORES HEARING CENTER
Entity type:Organization
Organization Name:ST CLAIR SHORES HEARING CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-200-3025
Mailing Address - Street 1:30128 HARPER AVE
Mailing Address - Street 2:STE 1A
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48082-1662
Mailing Address - Country:US
Mailing Address - Phone:586-200-3025
Mailing Address - Fax:586-200-3028
Practice Address - Street 1:30128 HARPER AVE
Practice Address - Street 2:STE 1A
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48082-1662
Practice Address - Country:US
Practice Address - Phone:586-200-3025
Practice Address - Fax:586-200-3028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment