Provider Demographics
NPI:1508193335
Name:SUMTER & MARION HEARING, INC.
Entity Type:Organization
Organization Name:SUMTER & MARION HEARING, INC.
Other - Org Name:MIRACLE EAR HEARING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEIDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:CO-OWNER
Authorized Official - Phone:352-572-0033
Mailing Address - Street 1:11251 COUNTY ROAD 223
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:FL
Mailing Address - Zip Code:34484-3377
Mailing Address - Country:US
Mailing Address - Phone:352-572-0033
Mailing Address - Fax:352-291-1794
Practice Address - Street 1:9570 SW HIGHWAY 200
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-7720
Practice Address - Country:US
Practice Address - Phone:352-291-1467
Practice Address - Fax:352-291-1794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-16
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
J8106OtherBLUE CROSS/BLUE SHIELD