Basic Information
| Provider Information | |||||||||
| NPI: | 1588975015 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MINLY INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | MIRACLE EAR | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 11900 US HIGHWAY 280 | ||||||||
| Address2: | |||||||||
| City: | ELLABELL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313083603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8432708929 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8530 N WICKHAM RD | ||||||||
| Address2: | #114 | ||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329406616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3212591029 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2010 | ||||||||
| LastUpdateDate: | 06/30/2010 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | ARTHUR | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8432708929 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
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| AuthorizedOfficialCredential: | BC-HIS | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332S00000X | 885047401 | FL | Y | Suppliers | Hearing Aid Equipment |
No ID Information.