1568643591 NPI number — MIRACLE EAR

Table of content: (NPI 1568643591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568643591 NPI number — MIRACLE EAR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIRACLE EAR
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:
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:
1568643591
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5000 CHESHIRE LN N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55446-3706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-333-9152
Provider Business Mailing Address Fax Number:
763-268-4240

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 QUINTARD DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
OXFORD
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36203-1849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-831-9119
Provider Business Practice Location Address Fax Number:
256-831-9019
Provider Enumeration Date:
11/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
D'AMICO
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
M
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
888-333-9152

Provider Taxonomy Codes

  • Taxonomy code: 237600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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