Basic Information
| Provider Information | |||||||||
| NPI: | 1730192030 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAGINAW VALLEY HEARING CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3175 CHRISTY WAY | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897991611 | ||||||||
| FaxNumber: | 9897991622 | ||||||||
| Practice Location | |||||||||
| Address1: | 3175 CHRISTY WAY | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897991611 | ||||||||
| FaxNumber: | 9897991622 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HARE | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9897991611 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 123867 | 01 | GREAT LAKES | OTHER | 640G37631 | 01 | BCBS | OTHER | 3048554 | 01 | MOLINA 90 CODE | OTHER | 5018429 | 01 | MOLINA 80 CODE | OTHER | 640G32681 | 01 | HP | OTHER |