=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003999079
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | B & S UNITED AGENCY D/B/A MIRACLE EAR
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1321 W SAINTE MARIES ST STE A
-----------------------------------------------------
City | PERRYVILLE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63775-1596
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-547-2346
-----------------------------------------------------
Fax | 573-547-6228
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1321 W SAINTE MARIES ST STE A
-----------------------------------------------------
City | PERRYVILLE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63775-1596
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-547-2346
-----------------------------------------------------
Fax | 573-547-6228
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FRANCHISEE
-----------------------------------------------------
Name | MRS. JOYCE A. HILL-COOLEY
-----------------------------------------------------
Credential | R.N., BC-HIS
-----------------------------------------------------
Telephone | 573-547-2346
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | 000816
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------