Basic Information
| Provider Information | |||||||||
| NPI: | 1225245863 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | INDIANA HEARING LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | MIRACLE EAR | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 131 ENTERPRISE RD | ||||||||
| Address2: | |||||||||
| City: | JOHNSTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120953326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013534174 | ||||||||
| FaxNumber: | 4014885774 | ||||||||
| Practice Location | |||||||||
| Address1: | 1801 SOUTH STATE ROAD 57 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122540206 | ||||||||
| FaxNumber: | 8122540203 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2007 | ||||||||
| LastUpdateDate: | 05/03/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | STEELE | ||||||||
| AuthorizedOfficialFirstName: | KAYLA | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR CONTRACT NEGOTIATOR | ||||||||
| AuthorizedOfficialTelephone: | 5186204238 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332S00000X | Y | Suppliers | Hearing Aid Equipment |
No ID Information.