Provider Demographics
NPI:1548402704
Name:MILLENNIUM HEARING SERVICES INC.
Entity Type:Organization
Organization Name:MILLENNIUM HEARING SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF AUDIOLOGY, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MULVEY
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:707-542-1154
Mailing Address - Street 1:4725 HOEN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-7862
Mailing Address - Country:US
Mailing Address - Phone:707-542-1154
Mailing Address - Fax:707-542-4818
Practice Address - Street 1:4725 HOEN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-7862
Practice Address - Country:US
Practice Address - Phone:707-542-1154
Practice Address - Fax:707-542-4818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1683237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ229512YOtherMEDICARE PTAN
CAAU0016830Medicaid