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General NPI Number Information
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NPI Number | 1134741150
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Entity Type | Organization
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Legal Business Name | MIRACLE EAR
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Dates
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Enumeration Date | 05/13/2020
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Last Update Date | 05/13/2020
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Provider Practice Location Address
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Address Line | 159 BUTLER RD
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City | KITTANNING
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State | PA
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Zip | 16201-2328
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Country | US
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Telephone | 724-548-1605
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Fax |
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Provider Business Mailing Address
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Address Line | 159 BUTLER RD
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City | KITTANNING
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State | PA
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Zip | 16201-2328
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Country | US
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Telephone | 724-548-1605
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MASON MENELL
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Credential |
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Telephone | 724-548-1605
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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License Number |
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License Number State |
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