Basic Information
Provider Information
NPI: 1477227247
EntityType: 2
ReplacementNPI:  
OrganizationName: LISTEN HEAR LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: MIRACLE EAR
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 131 ENTERPRISE RD
Address2:  
City: JOHNSTOWN
State: NY
PostalCode: 120953326
CountryCode: US
TelephoneNumber: 5186204238
FaxNumber: 5186205727
Practice Location
Address1: 801 S COLLEGE AVE STE 2
Address2:  
City: BLUEFIELD
State: VA
PostalCode: 246051753
CountryCode: US
TelephoneNumber: 5769700576
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/05/2021
LastUpdateDate: 11/09/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: THOMPSON
AuthorizedOfficialFirstName: GREG
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: HEARING INSTRUMENT SPECIALIST
AuthorizedOfficialTelephone: 2769700576
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/09/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
332S00000X  Y SuppliersHearing Aid Equipment 

No ID Information.


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