Provider Demographics
NPI:1487847323
Name:MID-SOUTH HEARING, LLC
Entity Type:Organization
Organization Name:MID-SOUTH HEARING, LLC
Other - Org Name:MIRACLE-EAR HEARING AID CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:731-668-3165
Mailing Address - Street 1:888 COUNTY ROAD 115
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-9518
Mailing Address - Country:US
Mailing Address - Phone:731-668-3165
Mailing Address - Fax:731-668-9860
Practice Address - Street 1:2021 GREYSTONE SQ
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3576
Practice Address - Country:US
Practice Address - Phone:731-668-3165
Practice Address - Fax:731-668-9860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN658237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1B4080841OtherBLUE CROSS BLUE SHIELD