Provider Demographics
NPI:1184337263
Name:MIRACLE 3D MOMENTS, LLC
Entity type:Organization
Organization Name:MIRACLE 3D MOMENTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ SONOGRAPHER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HELLER
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS
Authorized Official - Phone:320-245-7701
Mailing Address - Street 1:8182 PARADISE BEACH RD
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-1864
Mailing Address - Country:US
Mailing Address - Phone:320-761-5062
Mailing Address - Fax:833-938-4654
Practice Address - Street 1:22 WILSON AVE NE STE 201
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56304-0418
Practice Address - Country:US
Practice Address - Phone:320-208-6064
Practice Address - Fax:833-938-4654
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIRACLE 3D MOMENTS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty