Healthcare Provider Details

I. General information

NPI: 1922562503
Provider Name (Legal Business Name): MIRZA HEARING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 W SPRUCE ST STE 2
MISSOULA MT
59802-4029
US

IV. Provider business mailing address

712 W SPRUCE ST STE 2
MISSOULA MT
59802-4029
US

V. Phone/Fax

Practice location:
  • Phone: 406-543-5690
  • Fax:
Mailing address:
  • Phone: 406-543-5690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. USMAN MIRZA
Title or Position: OWNER
Credential: HIS
Phone: 208-840-0025