Provider Demographics
NPI: | 1083829717 |
---|---|
Name: | BAINBRIDGE LLC |
Entity Type: | Organization |
Organization Name: | BAINBRIDGE LLC |
Other - Org Name: | MIRACLE EAR |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | HEARING INSTRUMENT SPECIALIST |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JASON |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | FRASIER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 585-453-2811 |
Mailing Address - Street 1: | 131 ENTERPRISE RD |
Mailing Address - Street 2: | |
Mailing Address - City: | JOHNSTOWN |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 12095-3326 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 585-453-2811 |
Mailing Address - Fax: | 585-453-0759 |
Practice Address - Street 1: | 1570 W RIDGE RD |
Practice Address - Street 2: | |
Practice Address - City: | ROCHESTER |
Practice Address - State: | NY |
Practice Address - Zip Code: | 14615-2501 |
Practice Address - Country: | US |
Practice Address - Phone: | 585-453-2811 |
Practice Address - Fax: | 585-453-0759 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-05-14 |
Last Update Date: | 2020-06-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332S00000X | Suppliers | Hearing Aid Equipment |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | ========= | Other | EIN NUMBER |