Provider Demographics
NPI:1093972580
Name:CONNOR ENTERPRISES MINNESOTA, INC.
Entity Type:Organization
Organization Name:CONNOR ENTERPRISES MINNESOTA, INC.
Other - Org Name:MIRACLE EAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-424-0722
Mailing Address - Street 1:1631 4TH ST SW
Mailing Address - Street 2:STE 111
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-1612
Mailing Address - Country:US
Mailing Address - Phone:641-424-0722
Mailing Address - Fax:641-424-4143
Practice Address - Street 1:1631 4TH ST SW
Practice Address - Street 2:STE 111
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-1612
Practice Address - Country:US
Practice Address - Phone:641-424-0722
Practice Address - Fax:641-424-4143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9058995332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment