Provider Demographics
NPI:1093981797
Name:WISCONSIN HEARING AIDS INC
Entity type:Organization
Organization Name:WISCONSIN HEARING AIDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEARING INSTRUMENT SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DUDLEY
Authorized Official - Last Name:PIPPIN
Authorized Official - Suffix:
Authorized Official - Credentials:BCHIS
Authorized Official - Phone:608-244-1221
Mailing Address - Street 1:1310 MENDOTA ST #113
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53714-1092
Mailing Address - Country:US
Mailing Address - Phone:608-244-1221
Mailing Address - Fax:608-244-3050
Practice Address - Street 1:1310 MENDOTA ST #113
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53714-1092
Practice Address - Country:US
Practice Address - Phone:608-244-1221
Practice Address - Fax:608-244-3050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI104237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42813700Medicaid