Healthcare Provider Details

I. General information

NPI: 1083845697
Provider Name (Legal Business Name): MIRACLE-EAR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2009
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3917 BROADWAY
MT. VERNON IL
62864
US

IV. Provider business mailing address

5000 CHESHIRE PKWY N
PLYMOUTH MN
55446-4103
US

V. Phone/Fax

Practice location:
  • Phone: 618-242-1120
  • Fax: 618-242-4171
Mailing address:
  • Phone: 763-268-4115
  • Fax: 763-268-4017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name: DEBRA GRAN
Title or Position: SENIOR VICE PRESIDENT HUMAN RESOURC
Credential:
Phone: 763-268-4115