Provider Demographics
NPI:1285804021
Name:MIRACLE EAR OF COLUMBIA
Entity type:Organization
Organization Name:MIRACLE EAR OF COLUMBIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DISPENSER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:T
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:STATE LICENSE 000458
Authorized Official - Phone:931-388-8595
Mailing Address - Street 1:1617 HATCHER LANE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4826
Mailing Address - Country:US
Mailing Address - Phone:931-388-8595
Mailing Address - Fax:931-381-8974
Practice Address - Street 1:1617 HATCHER LANE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4826
Practice Address - Country:US
Practice Address - Phone:931-388-8595
Practice Address - Fax:931-381-8974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000458237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty