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General NPI Number Information
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NPI Number | 1669698775
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Entity Type | Organization
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Legal Business Name | BRAD MCMILLIN, INC
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 04/22/2009
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Provider Practice Location Address
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Address Line | 1011 COMMERCE DR
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City | FAIRFIELD
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State | IL
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Zip | 62837-2364
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Country | US
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Telephone | 618-842-4315
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Fax | 618-842-4360
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Provider Business Mailing Address
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Address Line | 1415 WEST HIGHWAY 50
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City | O'FALLON
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State | IL
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Zip | 62269
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Country | US
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Telephone | 618-624-4471
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Fax | 618-624-4496
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Authorized Official
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Title or Position | ACCOUNTS RECEIVABLE
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Name | PATTY L MCCUBBINS
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Credential |
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Telephone | 618-624-4471
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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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