Provider Demographics
NPI:1205283728
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:MS
Authorized Official - First Name:LYNDSAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:545-887-2318
Mailing Address - Street 1:1012 W PIERCE ST STE A
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-4034
Mailing Address - Country:US
Mailing Address - Phone:575-887-2318
Mailing Address - Fax:575-887-0189
Practice Address - Street 1:1012 W PIERCE ST STE A
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-4034
Practice Address - Country:US
Practice Address - Phone:575-887-2318
Practice Address - Fax:575-887-0189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0867237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty