1134265143 NPI number — SUPERIOR HEARING COMPANY, INC.

Table of content: (NPI 1134265143)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134265143 NPI number — SUPERIOR HEARING COMPANY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUPERIOR HEARING COMPANY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MIRACLE-EAR
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134265143
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 623
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTERTOWN
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46748-0623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-483-2700
Provider Business Mailing Address Fax Number:
260-484-1620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 ELIDA RD
Provider Second Line Business Practice Location Address:
SEARS HEARING - LIMA MALL
Provider Business Practice Location Address City Name:
LIMA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45805-1299
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-331-5965
Provider Business Practice Location Address Fax Number:
419-331-8646
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROBINSON
Authorized Official First Name:
JO
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
260-483-2700

Provider Taxonomy Codes

  • Taxonomy code: 332S00000X , with the licence number:  02573 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 22000000258609 . This is a "ANTHEM BC-BS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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