Healthcare Provider Details

I. General information

NPI: 1285850396
Provider Name (Legal Business Name): BRAD MCMILLIN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 04/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3307 BROADWAY ST SUITE 160
MOUNT VERNON IL
62864-2347
US

IV. Provider business mailing address

1514 WEST HIGHWAY 50
O'FALLON IL
62269
US

V. Phone/Fax

Practice location:
  • Phone: 618-242-4901
  • Fax: 618-242-2458
Mailing address:
  • Phone: 618-624-4471
  • Fax: 618-624-4496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: PATTY L MCCUBBINS
Title or Position: ACCOUNTS RECEIVABLE
Credential:
Phone: 618-624-4471