Provider Demographics
NPI:1932255981
Name:GREENLUND ENTERPRISES
Entity Type:Organization
Organization Name:GREENLUND ENTERPRISES
Other - Org Name:MIRACLE EAR CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:R
Authorized Official - Last Name:LAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-831-8966
Mailing Address - Street 1:1802 GALLOWAY ST
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-3467
Mailing Address - Country:US
Mailing Address - Phone:715-831-8966
Mailing Address - Fax:
Practice Address - Street 1:565 COUNTY RD HQ
Practice Address - Street 2:SUITE 5
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-8855
Practice Address - Country:US
Practice Address - Phone:906-228-3577
Practice Address - Fax:906-228-9670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI904684997Medicaid