Provider Demographics
NPI:1275772659
Name:HEAR MONTANA, INC
Entity Type:Organization
Organization Name:HEAR MONTANA, INC
Other - Org Name:MIRACLE-EAR CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLENBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-543-5690
Mailing Address - Street 1:1511 S RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-3629
Mailing Address - Country:US
Mailing Address - Phone:406-543-5690
Mailing Address - Fax:406-543-9834
Practice Address - Street 1:1511 S RUSSELL ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-3629
Practice Address - Country:US
Practice Address - Phone:406-543-5690
Practice Address - Fax:406-543-9834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT312237700000X
MT321237700000X
MT345237700000X
MT202237700000X
MT210237700000X
MT347237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty