Provider Demographics
NPI:1265425128
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
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:414-272-1466
Mailing Address - Street 1:823 N 2ND ST
Mailing Address - Street 2:SUITE 213
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53203-1818
Mailing Address - Country:US
Mailing Address - Phone:414-272-1466
Mailing Address - Fax:414-272-1467
Practice Address - Street 1:823 N 2ND ST
Practice Address - Street 2:SUITE 213
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53203-1818
Practice Address - Country:US
Practice Address - Phone:414-272-1466
Practice Address - Fax:414-272-1467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI332S00000X332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42821400Medicaid