Organization
BRAD MCMILLIN INC
Active
Other names
BELTONE HEARING AID SERVICE
Organization subpart
No
Provider details
NPI number
Authorized official
PATTY L MCCUBBINS (ACCOUNTS RECEIVABLE MANAGER)
(618) 624-4471
Entity
Organization
Contact information
Practice address
1367 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-3313
(573) 776-7800
(573) 701-0103
Mailing address
1415 WEST HIGHWAY 50, O'FALLON, IL 62269-3313
(618) 624-4471
(618) 624-4496
Taxonomy
Speciality
Code
Description
License number
State
332S00000X
Hearing Aid Equipment
Primary
MO2008036838
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8215212
BLUE CROSS BLUE SHIELD OF IL
IL
Enumeration date
09/11/2008
Last updated
04/24/2009
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