Provider Demographics
NPI:1912535832
Name:MIRACLE EAR
Entity Type:Organization
Organization Name:MIRACLE EAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEARING INSTRUMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GEDNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-683-2609
Mailing Address - Street 1:1915 W PARRISH AVENUE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-3519
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1915 W PARRISH AVENUE
Practice Address - Street 2:SUITE 400
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-3519
Practice Address - Country:US
Practice Address - Phone:270-683-2609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty