Provider Demographics
NPI:1215206347
Name:PICKART HEARING SERVICE, LLC
Entity Type:Organization
Organization Name:PICKART HEARING SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEARING INSTRUMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PICKART
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:920-926-1288
Mailing Address - Street 1:481 E DIVISION ST STE 900
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-3752
Mailing Address - Country:US
Mailing Address - Phone:920-926-1288
Mailing Address - Fax:
Practice Address - Street 1:481 E DIVISION ST STE 900
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-3752
Practice Address - Country:US
Practice Address - Phone:920-926-1288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1353-060332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment