Basic Information
Provider Information | |||||||||
NPI: | 1043535206 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | LYMIN INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | MIRACLE EAR | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 11900 US HIGHWAY 280 | ||||||||
Address2: |   | ||||||||
City: | ELLABELL | ||||||||
State: | GA | ||||||||
PostalCode: | 313083603 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8432708929 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 9880 DORCHESTER RD | ||||||||
Address2: |   | ||||||||
City: | SUMMERVILLE | ||||||||
State: | SC | ||||||||
PostalCode: | 294858545 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8436951611 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/31/2010 | ||||||||
LastUpdateDate: | 03/31/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SMITH | ||||||||
AuthorizedOfficialFirstName: | ARTHUR | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 8432708929 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | BC-HIS | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332S00000X | LIC-2-10-44334 | SC | Y |   | Suppliers | Hearing Aid Equipment |   |
No ID Information.