Provider Demographics
NPI:1366604084
Name:PORTAGE HEARING SERVICES
Entity type:Organization
Organization Name:PORTAGE HEARING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCCA
Authorized Official - Phone:906-483-1455
Mailing Address - Street 1:500 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-1569
Mailing Address - Country:US
Mailing Address - Phone:906-483-1455
Mailing Address - Fax:906-483-1457
Practice Address - Street 1:500 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-1569
Practice Address - Country:US
Practice Address - Phone:906-483-1455
Practice Address - Fax:906-483-1457
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PORTAGE HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-25
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000364332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI905257894Medicaid
MI540C102750OtherBLUE CROSS
MINR000364OtherBLUE CROSS