Provider Demographics
NPI:1891197521
Name:MADMAC, INC.
Entity Type:Organization
Organization Name:MADMAC, INC.
Other - Org Name:MIRACLE-EAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-540-4327
Mailing Address - Street 1:2643 SE 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-3250
Mailing Address - Country:US
Mailing Address - Phone:239-433-1938
Mailing Address - Fax:239-454-7691
Practice Address - Street 1:2643 SE 19TH AVE
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-3250
Practice Address - Country:US
Practice Address - Phone:239-433-1938
Practice Address - Fax:239-454-7691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJ8164OtherBLUE CROSS BLUE SHIELD