Healthcare Provider Details

I. General information

NPI: 1285804021
Provider Name (Legal Business Name): MIRACLE EAR OF COLUMBIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 HATCHER LANE
COLUMBIA TN
38401-4826
US

IV. Provider business mailing address

1617 HATCHER LANE
COLUMBIA TN
38401-4826
US

V. Phone/Fax

Practice location:
  • Phone: 931-388-8595
  • Fax: 931-381-8974
Mailing address:
  • Phone: 931-388-8595
  • Fax: 931-381-8974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number000458
License Number StateTN

VIII. Authorized Official

Name: MR. ROSS T OSBORNE
Title or Position: PRESIDENT DISPENSER
Credential: STATE LICENSE 000458
Phone: 931-388-8595