Provider Demographics
NPI:1508073008
Name:A MIRACLE OF HEARING
Entity Type:Organization
Organization Name:A MIRACLE OF HEARING
Other - Org Name:BETTER HEARING, HEARING AID CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:MUSSON
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:559-781-1962
Mailing Address - Street 1:504 W PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3274
Mailing Address - Country:US
Mailing Address - Phone:559-781-1962
Mailing Address - Fax:
Practice Address - Street 1:504 W PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3274
Practice Address - Country:US
Practice Address - Phone:559-781-1962
Practice Address - Fax:559-684-0836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA0027960237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA0027960Medicaid
CA=========OtherSSN