Provider Demographics
NPI:1700119179
Name:PICKART HEARING SERVICE, LLC
Entity Type:Organization
Organization Name:PICKART HEARING SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PICKART
Authorized Official - Suffix:
Authorized Official - Credentials:BSHIS
Authorized Official - Phone:920-926-1288
Mailing Address - Street 1:481 E DIVISION ST
Mailing Address - Street 2:SUITE 900
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-3748
Mailing Address - Country:US
Mailing Address - Phone:920-926-1288
Mailing Address - Fax:920-926-0533
Practice Address - Street 1:481 E DIVISION ST
Practice Address - Street 2:SUITE 900
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-3748
Practice Address - Country:US
Practice Address - Phone:920-926-1288
Practice Address - Fax:920-926-0533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42857500Medicaid