Provider Demographics
NPI:1568114841
Name:MINER AUDIOLOGY, LLC
Entity Type:Organization
Organization Name:MINER AUDIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:M
Authorized Official - Last Name:MINER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:684-252-3552
Mailing Address - Street 1:PO BOX 6590
Mailing Address - Street 2:
Mailing Address - City:PAGO PAGO
Mailing Address - State:AS
Mailing Address - Zip Code:96799-6286
Mailing Address - Country:US
Mailing Address - Phone:684-252-3552
Mailing Address - Fax:
Practice Address - Street 1:MINER AUDIOLOGY
Practice Address - Street 2:ROUTE 1 ATU'U
Practice Address - City:PAGO PAGO
Practice Address - State:AS
Practice Address - Zip Code:96799
Practice Address - Country:US
Practice Address - Phone:684-252-3552
Practice Address - Fax:808-517-5850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech