Provider Demographics
NPI:1801002894
Name:WISCONSIN HEARING AID CENTERS
Entity Type:Organization
Organization Name:WISCONSIN HEARING AID CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT - CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:414-463-0200
Mailing Address - Street 1:1300 S GREENBAY RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4469
Mailing Address - Country:US
Mailing Address - Phone:262-634-4500
Mailing Address - Fax:
Practice Address - Street 1:1300 S GREENBAY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-4469
Practice Address - Country:US
Practice Address - Phone:262-634-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42857700Medicaid