MEDICARE: MIRACLE EAR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist

General Provider Information

NPI Number	:	1912535832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIRACLE EAR

Provider Business Mailing Address
First Line	:	1915 W PARRISH AVENUE
Second Line	:	SUITE 400
City	:	OWENSBORO
State	:	KY
Zip	:	42301-3519
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1915 W PARRISH AVENUE
Second Line	:	SUITE 400
City	:	OWENSBORO
State	:	KY
Zip	:	42301-3519
Country	:	US
Telephone Number	:	270-683-2609
Fax Number	:

Authorized Official
Title or Position	:	HEARING INSTRUMENT SPECIALIST
Name	:	KRISTEN GEDNEY
Credential	:
Telephone Number	:	270-683-2609

Provider Enumeration Date	:	03/27/2020
Last Update Date	:	03/27/2020

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