Basic Information
| Provider Information | |||||||||
| NPI: | 1760944417 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HART HEARING LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 51122 ROMEO PLANK RD | ||||||||
| Address2: | |||||||||
| City: | MACOMB | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480424111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5864731221 | ||||||||
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| Practice Location | |||||||||
| Address1: | 51122 ROMEO PLANK RD | ||||||||
| Address2: | |||||||||
| City: | MACOMB | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480424111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5864731221 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2019 | ||||||||
| LastUpdateDate: | 04/02/2019 | ||||||||
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| AuthorizedOfficialLastName: | RINEHART | ||||||||
| AuthorizedOfficialFirstName: | NICOLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/HIS | ||||||||
| AuthorizedOfficialTelephone: | 5864731221 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | B.A., BC-HIS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
ID Information
| ID | Type | State | Issuer | Description | 3501006412 | 01 | MI | BCBS OF MI | OTHER |