Provider Demographics
NPI:1982854535
Name:CARPENTER EAR AND HEARING SC
Entity Type:Organization
Organization Name:CARPENTER EAR AND HEARING SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:920-469-3209
Mailing Address - Street 1:1808 ALLOUEZ AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-6280
Mailing Address - Country:US
Mailing Address - Phone:920-469-3209
Mailing Address - Fax:
Practice Address - Street 1:1808 ALLOUEZ AVE.
Practice Address - Street 2:SUITE D
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6280
Practice Address - Country:US
Practice Address - Phone:920-469-3209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI98-156261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41119000Medicaid