Provider Demographics
NPI:1275838799
Name:MBD LLC DBA MIRACLE EAR
Entity Type:Organization
Organization Name:MBD LLC DBA MIRACLE EAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAESTAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-451-5363
Mailing Address - Street 1:P.O. BOX 778238
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89077
Mailing Address - Country:US
Mailing Address - Phone:702-451-5363
Mailing Address - Fax:702-451-5515
Practice Address - Street 1:1245 W. WARM SPRINGS RD
Practice Address - Street 2:(INSIDE SEARS MIRACLE EAR HEARING
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014
Practice Address - Country:US
Practice Address - Phone:702-451-5363
Practice Address - Fax:702-451-5515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV#256237700000X
NVNV256332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Single Specialty