Provider Demographics
NPI:1952447062
Name:SUPREME HEARING COMPANY, INC.
Entity Type:Organization
Organization Name:SUPREME HEARING COMPANY, INC.
Other - Org Name:MIRACLE-EAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JO
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-483-2700
Mailing Address - Street 1:PO BOX 623
Mailing Address - Street 2:
Mailing Address - City:HUNTERTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46748-0623
Mailing Address - Country:US
Mailing Address - Phone:260-483-2700
Mailing Address - Fax:260-484-1620
Practice Address - Street 1:101 W WASHINGTON CENTER RD STE C
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-4357
Practice Address - Country:US
Practice Address - Phone:260-482-8503
Practice Address - Fax:260-484-1620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INNONE332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN22000000182087OtherANTHEM BC-BS