Tabitha Farley Bucknam, M.S.
Individual provider Active NPI Audiologist · Burton, MI
NPI 1104938604 · NPPES record last updated May 1, 2008
Key facts
- NPI
- 1104938604
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Audiologist 231H00000X
- Practice address
- 1501 S Center Rd
Suite B
Burton, MI 48509-1731 - Phone
- (810) 742-0225
- Fax
- (810) 742-7990
- NPI assigned
- Aug 31, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Qualified Audiologist
- Education
- Other, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Genesee ENT Associates PC
Practice addresses (Care Compare)
1501 S Ctr Rd
BLDG B
Burton, MI 48509-1731
Phone (810) 742-0225
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080816000025 | MI | Practitioner - Qualified Audiologist | 8224103833 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Genesee ENT Associates PC | Current |
Accepting new patients |
Locations
1501 S Center Rd
Bldg B
Burton, MI 48509
Phone (810) 742-0225
1501 S Center Rd
Ste B
Burton, MI 48509
Phone (810) 742-0225
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | Yes |
Addresses
Primary practice location
1501 S Center Rd
Suite B
Burton, MI 48509-1731
Mailing address
1501 S Center Rd
Suite B
Burton, MI 48509-1731
Phone (810) 742-0225
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4742240 | Medicaid | MI |
Other providers in Burton, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 1, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.