1396328894 NPI number — MIRACLE EAR, INC

Table of content: (NPI 1396328894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396328894 NPI number — MIRACLE EAR, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIRACLE EAR, 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:
Provider Other Organization Name Type Code:
6
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:
1396328894
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 S 5TH ST STE 2300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55402-4223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-268-4286
Provider Business Mailing Address Fax Number:
763-268-4427

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1402 S PARKER RD STE A-106
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80231-2758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-755-1733
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MURPHY
Authorized Official First Name:
KAYLYNN
Authorized Official Middle Name:
Authorized Official Title or Position:
LEAD BILLING SPECIALIST
Authorized Official Telephone Number:
763-268-4286

Provider Taxonomy Codes

  • Taxonomy code: 237700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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