Provider Demographics
NPI:1922562503
Name:MIRZA HEARING SERVICES LLC
Entity Type:Organization
Organization Name:MIRZA HEARING SERVICES LLC
Other - Org Name:MIRACLE - EAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:USMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRZA
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:208-840-0025
Mailing Address - Street 1:712 W SPRUCE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4029
Mailing Address - Country:US
Mailing Address - Phone:406-543-5690
Mailing Address - Fax:
Practice Address - Street 1:712 W SPRUCE ST STE 2
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4029
Practice Address - Country:US
Practice Address - Phone:406-543-5690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech