Provider Demographics
NPI:1275891962
Name:IDEALICS, LLC
Entity Type:Organization
Organization Name:IDEALICS, LLC
Other - Org Name:THE HEARING PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:FOURNIER
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:406-452-3247
Mailing Address - Street 1:1301 11TH AVE S STE 4
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4654
Mailing Address - Country:US
Mailing Address - Phone:406-452-2437
Mailing Address - Fax:406-216-5962
Practice Address - Street 1:1301 11TH AVE S STE 4
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4654
Practice Address - Country:US
Practice Address - Phone:406-452-2437
Practice Address - Fax:406-216-5962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT225332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment