Advanced Audiology, LLC
Organization Active NPI Audiologist-Hearing Aid Fitter · Dewitt, MI
NPI 1235303538 · NPPES record last updated Jun 21, 2018
Key facts
- NPI
- 1235303538
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Audiologist-Hearing Aid Fitter 237600000X
- License
- 1601000153 (MI)
- Legal business name
- ADVANCED AUDIOLOGY, LLC
- Practice address
- 12775 Escanaba Dr
Suite 3
Dewitt, MI 48820-8615 - Phone
- (517) 669-8080
- Fax
- (517) 669-8070
- NPI assigned
- Apr 17, 2008
- Organization subpart
- No
Authorized official
- Name
- Dr. Linda K. Wright, AUD., CCC-A
- Title
- Audiologist
- Phone
- (517) 669-8080
Subparts reporting this organization as parent 1
Corporate family (same tax ID) 1
Practitioners 3
-
Linda Kay Wright, AUD
-
Gabrielle Eliza Gwaltney, AU.D
-
Jacklyn Anne Miller, AU.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100116000272 | MI | Part B Supplier - Clinic/Group Practice | 2466594296 |
Receives reassigned benefits from 3 practitioners Practice locations: Dewitt, MI; Haslett, MI |
National Provider Directory
- Tax ID family
- Advanced Audiology LLC
Locations
12775 Escanaba Dr
Ste 3A
Dewitt, MI 48820
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist-Hearing Aid Fitter |
237600000X | 1601000153 | MI | Yes |
Addresses
Primary practice location
12775 Escanaba Dr
Suite 3
Dewitt, MI 48820-8615
Mailing address
12775 Escanaba Dr
Suite 3
Dewitt, MI 48820-8615
Phone (517) 669-8080
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200000000483 | Other | PHYSICIANS HEALTH PLAN MM | |
| 80-4678229 | Medicaid | MI | |
| 1932141983 | Other | MI | NPI, TYPE 1 |
| 1007674 | Other | MI | MCLAREN HEALTH PLAN |
| 1007674 | Other | MI | MCLAREN HEALTH ADVANTAGE |
| 54OA900140 | Other | MI | BLUE CROSS BLUE SHIELD MI |
| 64OA900130 | Other | MI | BLUE CROSS BLUE SHIELD MI |
| 90-4658208 | Medicaid | MI |
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All providers in Dewitt, MI · Audiologist-Hearing Aid Fitter in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 21, 2018. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.