Provider Demographics
NPI:1609011659
Name:THURSTON ENTERPRISE, INC. D.B.A. MIRACLE EAR
Entity Type:Organization
Organization Name:THURSTON ENTERPRISE, INC. D.B.A. MIRACLE EAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOPROSTHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ORSON
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:THURSTON
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS, ACA
Authorized Official - Phone:801-224-9444
Mailing Address - Street 1:682 N 500 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-1503
Mailing Address - Country:US
Mailing Address - Phone:801-224-9444
Mailing Address - Fax:801-224-5594
Practice Address - Street 1:682 N 500 W
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-1503
Practice Address - Country:US
Practice Address - Phone:801-224-9444
Practice Address - Fax:801-224-5594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT273857-4601261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech