Provider Demographics
NPI:1154839587
Name:THE SHIELD LLC.
Entity Type:Organization
Organization Name:THE SHIELD LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CFO
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:JANIKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-446-2333
Mailing Address - Street 1:103A JONES AVE
Mailing Address - Street 2:
Mailing Address - City:HATLEY
Mailing Address - State:WI
Mailing Address - Zip Code:54440-9707
Mailing Address - Country:US
Mailing Address - Phone:715-446-2333
Mailing Address - Fax:715-446-5055
Practice Address - Street 1:103A JONES AVE
Practice Address - Street 2:
Practice Address - City:HATLEY
Practice Address - State:WI
Practice Address - Zip Code:54440-9707
Practice Address - Country:US
Practice Address - Phone:715-446-2333
Practice Address - Fax:715-446-5055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies