Provider Demographics
NPI:1437336047
Name:BRAD MCMILLIN, INC
Entity Type:Organization
Organization Name:BRAD MCMILLIN, INC
Other - Org Name:BELTONE HEARING AID SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE
Authorized Official - Prefix:
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCUBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-624-4471
Mailing Address - Street 1:1707 E MAIN ST STE 6
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-3156
Mailing Address - Country:US
Mailing Address - Phone:618-395-6300
Mailing Address - Fax:618-395-6300
Practice Address - Street 1:1707 E MAIN ST STE 6
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-3156
Practice Address - Country:US
Practice Address - Phone:618-395-6300
Practice Address - Fax:618-395-6300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL8215212OtherBC/BS OF ILLINOIS